Healthcare Provider Details

I. General information

NPI: 1982699898
Provider Name (Legal Business Name): LESLIE ANN NOWELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 KINTNER PKWY STE A
SUNBURY OH
43074-9368
US

IV. Provider business mailing address

44 KINTNER PKWY STE A
SUNBURY OH
43074-9368
US

V. Phone/Fax

Practice location:
  • Phone: 740-965-4362
  • Fax: 740-994-8455
Mailing address:
  • Phone: 740-965-4362
  • Fax: 740-994-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007160A
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: