Provider Demographics
NPI:1205822053
Name:TODD, LESLEY (CRNP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:TODD
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 1:29466 PINTAIL DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-9323
Mailing Address - Country:US
Mailing Address - Phone:410-770-5140
Mailing Address - Fax:410-770-5141
Practice Address - Street 1:120 BANJO LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1002
Practice Address - Country:US
Practice Address - Phone:410-758-1787
Practice Address - Fax:410-758-1789
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR064855363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD836LMedicare ID - Type Unspecified