MEDICARE: LESLIE BURTON CRNP

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	SP011839	PA

General Provider Information

NPI Number	:	1134497811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE BURTON CRNP

Provider Business Mailing Address
First Line	:	PO BOX 746722
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6722
Country	:	US
Telephone Number	:	773-352-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:	SUITE 119
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	215-843-9720
Fax Number	:	215-843-7313

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	01/23/2026

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