Provider Demographics
NPI:1275531873
Name:VERUCCI, LESLIE C (NP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:C
Last Name:VERUCCI
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-733-0374
Mailing Address - Fax:877-733-0370
Practice Address - Street 1:2600 GLASGOW AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-8350
Practice Address - Fax:302-623-4850
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DELB-0000160363LA2200X
MDAC000109363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00723970OtherRAILROAD MEDICARE
DE144008Medicare PIN