Provider Demographics
NPI:1962242883
Name:LESLIE, JAMIE (PHD, RN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 HARRISON AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7966
Mailing Address - Country:US
Mailing Address - Phone:513-964-0830
Mailing Address - Fax:
Practice Address - Street 1:6355 HARRISON AVE STE 8
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7966
Practice Address - Country:US
Practice Address - Phone:513-964-0830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN347381163W00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse