MEDICARE: MRS. LESLEY NUNN FNP

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	5006430	NC

General Provider Information

NPI Number	:	1396170593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLEY NUNN FNP

Provider Business Mailing Address
First Line	:	204 MALLOY ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-4477
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 MALLOY ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-4477
Country	:	US
Telephone Number	:	919-751-7665
Fax Number	:

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

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	09/06/2013

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