Provider Demographics
NPI:1164616421
Name:THOMAS, LESLIE D (CNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:D
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 16370
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43216-6370
Mailing Address - Country:US
Mailing Address - Phone:614-645-5500
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:3334 AGLER ROAD
Practice Address - Street 2:SUITE 2800
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3387
Practice Address - Country:US
Practice Address - Phone:614-645-1600
Practice Address - Fax:614-645-1348
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843856Medicaid