Provider Demographics
NPI:1659386415
Name:SLADE, LARESHIA L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LARESHIA
Middle Name:L
Last Name:SLADE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:LARESHIA
Other - Middle Name:L
Other - Last Name:SLADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 6411
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20792-6411
Mailing Address - Country:US
Mailing Address - Phone:301-322-9500
Mailing Address - Fax:301-322-2227
Practice Address - Street 1:1300 CARAWAY CT
Practice Address - Street 2:106
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5461
Practice Address - Country:US
Practice Address - Phone:301-322-9500
Practice Address - Fax:301-322-2227
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9208578363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306946000Medicaid