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General NPI Number Information
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NPI Number | 1104994813
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Entity Type | Individual
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Provider Name | LESLIE SHARP LEWIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 233 GILMER ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-3809
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Country | US
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Telephone | 336-342-6196
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 890195
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City | CHARLOTTE
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State | NC
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Zip | 28289-0195
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Country | US
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Telephone | 336-342-6196
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 103354
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License Number State | NC
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