Provider Demographics
NPI:1558891523
Name:LEATH-WARREN, CHRISTIE JANEL (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:JANEL
Last Name:LEATH-WARREN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:CHRISTIE
Other - Middle Name:JANEL
Other - Last Name:LEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 604050
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 OAK BRANCH DR STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2444
Practice Address - Country:US
Practice Address - Phone:336-579-2312
Practice Address - Fax:336-579-2365
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009588363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner