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General NPI Number Information
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NPI Number | 1306063599
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Entity Type | Individual
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Provider Name | LESLIE THOMAS CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 500 MEMORIAL AVE MEDICAL BLDG SUITE 307
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City | CUMBERLAND
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State | MD
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Zip | 21502-3732
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Country | US
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Telephone | 301-723-4965
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Fax | 301-723-4983
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Provider Business Mailing Address
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Address Line | PO BOX 1571 500 MEMORIAL AVE MEDICAL BLDG SUITE 307
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City | CUMBERLAND
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State | MD
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Zip | 21501-1571
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Country | US
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Telephone | 301-723-4965
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Fax | 301-723-4983
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R047459
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License Number State | MD
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