Provider Demographics
NPI:1518920321
Name:LEVEILLE, LESLIE A (NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2B WEST STREET
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:781-340-4293
Mailing Address - Fax:781-340-3782
Practice Address - Street 1:2 WEST ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1861
Practice Address - Country:US
Practice Address - Phone:781-340-4293
Practice Address - Fax:781-340-3782
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS92355Medicare UPIN
MANP4084Medicare UPIN