Provider Demographics
NPI:1629555727
Name:KOBERSTEIN, LESLIE D (NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:KOBERSTEIN
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 1:11835 FISHING POINT DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2584
Mailing Address - Country:US
Mailing Address - Phone:757-246-3146
Mailing Address - Fax:
Practice Address - Street 1:11835 FISHING POINT DR STE 104
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2584
Practice Address - Country:US
Practice Address - Phone:757-246-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11963220-4405363LF0000X
VA0024176309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily