Provider Demographics
NPI:1104881267
Name:LESLIE, JANICE MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7797 LOXLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6344
Mailing Address - Country:US
Mailing Address - Phone:910-868-6004
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4-2817 REILLY RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-7656
Practice Address - Fax:910-907-8075
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123975163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health