Healthcare Provider Details

I. General information

NPI: 1356875397
Provider Name (Legal Business Name): LESLIE MARIE STEGALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SOUTH ST
GREENFIELD OH
45123-1249
US

IV. Provider business mailing address

330 JEFFERSON ST
GREENFIELD OH
45123-1369
US

V. Phone/Fax

Practice location:
  • Phone: 740-403-9108
  • Fax: 937-462-1385
Mailing address:
  • Phone: 740-403-9108
  • Fax: 937-462-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020690
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.020690
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: