Healthcare Provider Details

I. General information

NPI: 1467571109
Provider Name (Legal Business Name): LESLIE R PRYOR RN,MSN,ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRACTITIONER PRYOR MSN CNP

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 ROUTE 70 EAST SUITE G-101
MARLTON NJ
08053-2345
US

IV. Provider business mailing address

777 ROUTE 70 EAST SUITE G-101
MARLTON NJ
08053-2345
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-9939
  • Fax: 856-983-9936
Mailing address:
  • Phone: 856-983-9939
  • Fax: 856-983-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN05924800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNN59248
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: