Healthcare Provider Details

I. General information

NPI: 1356106462
Provider Name (Legal Business Name): LESLIE DAWN EADS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SULLIVAN ST
RADFORD VA
24141-3102
US

IV. Provider business mailing address

302 SULLIVAN ST
RADFORD VA
24141-3102
US

V. Phone/Fax

Practice location:
  • Phone: 540-577-1619
  • Fax:
Mailing address:
  • Phone: 540-577-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023204768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: