Provider Demographics
NPI:1962647149
Name:WILLIAMS, LESLIE ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 STATE ROUTE 161
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-6754
Mailing Address - Country:US
Mailing Address - Phone:618-339-2114
Mailing Address - Fax:
Practice Address - Street 1:1998 STATE ROUTE 161
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-6754
Practice Address - Country:US
Practice Address - Phone:618-339-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007351OtherMEDICAL LICENSE