Provider Demographics
NPI:1497906283
Name:PING, LESLIE RENEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RENEE
Last Name:PING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:RENEE
Other - Last Name:HANSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5840 DAVIS CREEK RD
Mailing Address - Street 2:STE E
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1004
Mailing Address - Country:US
Mailing Address - Phone:304-736-6126
Mailing Address - Fax:304-736-1531
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:SUITE 6019
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-399-0137
Practice Address - Fax:304-399-0138
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV64649367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207026000OtherMAAC GROUP MEDICAID
WV3810013638Medicaid
WV9333201OtherMAAC GROUP MEDICARE