Provider Demographics
NPI:1255484382
Name:MCGILL-MAYOTTE, LESLIE ELLEN (NP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ELLEN
Last Name:MCGILL-MAYOTTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ELLEN
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4485 RIVERCHASE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5429
Mailing Address - Country:US
Mailing Address - Phone:248-792-4143
Mailing Address - Fax:
Practice Address - Street 1:26755 BALLARD ST
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-2419
Practice Address - Country:US
Practice Address - Phone:586-466-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217031163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care