Healthcare Provider Details

I. General information

NPI: 1164616421
Provider Name (Legal Business Name): LESLIE D THOMAS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE D MCGUIRE

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 AGLER ROAD SUITE 2800
COLUMBUS OH
43219-3387
US

IV. Provider business mailing address

P.O. BOX 16370
COLUMBUS OH
43216-6370
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-1600
  • Fax: 614-645-1348
Mailing address:
  • Phone: 614-645-5500
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-09543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: