Provider Demographics
NPI:1578645289
Name:DURHAM, LESLIE (RNC APN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:RNC APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 E BADDOUR PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3706
Mailing Address - Country:US
Mailing Address - Phone:615-444-5325
Mailing Address - Fax:615-444-2750
Practice Address - Street 1:927 E BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3706
Practice Address - Country:US
Practice Address - Phone:615-444-5325
Practice Address - Fax:615-444-2750
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 6412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6412OtherAPN LICENSE
TN83092OtherRN LICENSE