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General NPI Number Information
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NPI Number | 1467571109
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Entity Type | Individual
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Provider Name | LESLIE R PRYOR RN,MSN,ANP-C
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 777 ROUTE 70 EAST SUITE G-101
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City | MARLTON
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State | NJ
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Zip | 08053-2345
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Country | US
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Telephone | 856-983-9939
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Fax | 856-983-9936
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Provider Business Mailing Address
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Address Line | 777 ROUTE 70 EAST SUITE G-101
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City | MARLTON
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State | NJ
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Zip | 08053-2345
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Country | US
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Telephone | 856-983-9939
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Fax | 856-983-9936
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NN59248
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NN05924800
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License Number State | NJ
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