Healthcare Provider Details

I. General information

NPI: 1043677156
Provider Name (Legal Business Name): LESLIE WYLIE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12311 PERRY HWY
WEXFORD PA
15090-8344
US

IV. Provider business mailing address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 878-332-4242
  • Fax: 878-332-4485
Mailing address:
  • Phone: 412-359-3155
  • Fax: 412-359-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN581569
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN581569
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: