Provider Demographics
NPI:1043793789
Name:BOUCHERLE, LESLIE JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEAN
Last Name:BOUCHERLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0360
Mailing Address - Country:US
Mailing Address - Phone:888-339-6065
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:1287 CREEKSHIRE WAY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3057
Practice Address - Country:US
Practice Address - Phone:336-245-9521
Practice Address - Fax:855-308-2340
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant