Healthcare Provider Details

I. General information

NPI: 1326541780
Provider Name (Legal Business Name): LESLIE S ACTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 CENTRAL AVE
GREENVILLE OH
45331-1206
US

IV. Provider business mailing address

835 SWEITZER ST ATTN CHERYL JENNINGS
GREENVILLE OH
45331
US

V. Phone/Fax

Practice location:
  • Phone: 937-569-6996
  • Fax: 937-569-6079
Mailing address:
  • Phone: 937-569-6937
  • Fax: 937-569-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: