MEDICARE: LESLIE WRIGHT FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	363L00000X	IL

General Provider Information

NPI Number	:	1043077365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE WRIGHT FNP-C

Provider Business Mailing Address
First Line	:	8333 EXPRESS DR STE 0
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-6474
Country	:	US
Telephone Number	:	618-969-8683
Fax Number	:	618-969-8689

Provider Business Practice Location Address
First Line	:	8333 EXPRESS DR. SUITE D
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	618-969-8683
Fax Number	:	618-969-8689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	04/02/2026

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