Provider Demographics
NPI:1578818274
Name:TERRY, LESLIE MARIE (CNA/MA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:TERRY
Suffix:
Gender:F
Credentials:CNA/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 26TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4742
Mailing Address - Country:US
Mailing Address - Phone:757-602-7242
Mailing Address - Fax:
Practice Address - Street 1:1030 26TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4742
Practice Address - Country:US
Practice Address - Phone:757-602-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401126593374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide