MEDICARE: LESLIE ARCHIBALD NP-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	APRN.CNP.0030335	OH

General Provider Information

NPI Number	:	1134888605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ARCHIBALD NP-C

Provider Business Mailing Address
First Line	:	5195 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1913
Country	:	US
Telephone Number	:	513-231-4591
Fax Number	:

Provider Business Practice Location Address
First Line	:	5195 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1913
Country	:	US
Telephone Number	:	513-653-6770
Fax Number	:	513-832-8169

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

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	08/01/2023

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