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General NPI Number Information
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NPI Number | 1942917448
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Entity Type | Individual
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Provider Name | SUSAN LYNN LESLIE MS, RDN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 7810 BALLANTYNE COMMONS PKWY STE 221
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City | CHARLOTTE
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State | NC
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Zip | 28277-3416
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Country | US
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Telephone | 704-995-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 3051 PRIMROSE LANE
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City | YPSILANTI
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State | MI
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Zip | 48197-3213
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Country | US
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Telephone | 734-604-8266
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Fax | 833-315-0019
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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 | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number |
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License Number State |
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