Provider Demographics
NPI:1154678316
Name:CARGILE, LESLIE
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:CARGILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 VALERIE ARMS DR APT 818
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2138
Mailing Address - Country:US
Mailing Address - Phone:937-520-1772
Mailing Address - Fax:
Practice Address - Street 1:3460 VALERIE ARMS DR APT 818
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2138
Practice Address - Country:US
Practice Address - Phone:937-520-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide