Provider Demographics
NPI:1689676066
Name:LESLIE, MARJORIE L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:L
Last Name:LESLIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-681-4401
Mailing Address - Fax:412-681-7605
Practice Address - Street 1:4815 LIBERTY AVE STE 340
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-681-4401
Practice Address - Fax:412-681-4493
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004976M363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023110SDBMedicare PIN
PAS7229Medicare UPIN