Provider Demographics
NPI:1083050934
Name:JEWELL, LESLIE ADAIR (RN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ADAIR
Last Name:JEWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:RAE
Other - Last Name:ADAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5117 BAPTIST HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-6916
Mailing Address - Country:US
Mailing Address - Phone:843-889-2276
Mailing Address - Fax:843-889-2101
Practice Address - Street 1:5117 BAPTIST HILL RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-6916
Practice Address - Country:US
Practice Address - Phone:843-889-2276
Practice Address - Fax:843-889-2101
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29188163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool