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General NPI Number Information
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NPI Number | 1013193457
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Entity Type | Individual
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Provider Name | LESLIE M ANTONELLI MSN, RN
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Gender | Female
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1703 W STONES CROSSING RD STE 330
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City | GREENWOOD
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State | IN
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Zip | 46143-8558
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Country | US
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Telephone | 317-887-6060
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Fax | 317-859-5944
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28154154A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 71002959A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 71002959A
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License Number State | IN
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