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NPI Code Detail

MEDICARE: MISS LESLIE B MCDILL APRN, FNP

MEDICARE: MISS LESLIE B MCDILL APRN, 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
1363LF0000XFamily Nurse Practitioner3543SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13543OTHERSCSC BOARD OF NURSING

General Provider Information

NPI Number : 1417121831
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LESLIE B MCDILL APRN, FNP
Provider Business Mailing Address
First Line : PO BOX 743904
Second Line :
City : ATLANTA
State : GA
Zip : 30374-3904
Country : US
Telephone Number : 803-296-7033
Fax Number :
Provider Business Practice Location Address
First Line : 1333 TAYLOR ST STE 2B
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-2945
Country : US
Telephone Number : 803-251-6602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2008
Last Update Date : 08/24/2020

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