Provider Demographics
NPI:1891978425
Name:KLINEFELTER, LESLIE (CRNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:KLINEFELTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2102
Mailing Address - Country:US
Mailing Address - Phone:215-279-9666
Mailing Address - Fax:215-279-9674
Practice Address - Street 1:500 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2102
Practice Address - Country:US
Practice Address - Phone:215-279-9666
Practice Address - Fax:215-279-9674
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003575B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA054634Medicare PIN