Provider Demographics
NPI:1396861845
Name:MCCONNELL, LESLEY ANNE (CPNP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANNE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SILOPANNA RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1117
Mailing Address - Country:US
Mailing Address - Phone:410-268-3199
Mailing Address - Fax:
Practice Address - Street 1:277 PENINSULA FARM RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1018
Practice Address - Country:US
Practice Address - Phone:410-647-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114869363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics