Provider Demographics
NPI:1134497811
Name:BURTON, LESLIE (CRNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BURTON
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 1:300 FOUR FALLS CORPORATE CENTER, SUITE 260
Mailing Address - Street 2:
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:844-826-3446
Mailing Address - Fax:
Practice Address - Street 1:300 FOUR FALLS CORPORATE CENTER, SUITE 260
Practice Address - Street 2:
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428
Practice Address - Country:US
Practice Address - Phone:844-826-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily