Provider Demographics
NPI:1407416373
Name:BRAY, LESLIE WALLACE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:WALLACE
Last Name:BRAY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:OWLS HEAD
Mailing Address - State:ME
Mailing Address - Zip Code:04854-0452
Mailing Address - Country:US
Mailing Address - Phone:207-691-2140
Mailing Address - Fax:
Practice Address - Street 1:2399 ATLANTIC HWY
Practice Address - Street 2:
Practice Address - City:LINCOLNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04849-5322
Practice Address - Country:US
Practice Address - Phone:207-236-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine