Provider Demographics
NPI:1649215575
Name:HODEEN, LESLIE S (FNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:HODEEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:W
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7040
Mailing Address - Fax:757-446-7049
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024061366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherMULTIPLAN
VA-022OtherTRICARE/CHAMPUS
VAP01655816Medicare PIN
VA10110008NOtherOPTIMA HEALTH
VA1649215575OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherUSA MANAGED CARE
VA1649215575Medicaid
VAPAROtherCORVEL
VAS15790Medicare UPIN
VAVV1215BMedicare PIN
NC1649215575Medicaid