Provider Demographics
NPI:1730306101
Name:HALL, LESLIE S (RN, ENP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 SOUTH EASTSIDE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22980
Mailing Address - Country:US
Mailing Address - Phone:540-298-5550
Mailing Address - Fax:540-298-4077
Practice Address - Street 1:2778 SOUTH EASTSIDE HIGHWAY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22980
Practice Address - Country:US
Practice Address - Phone:540-298-5550
Practice Address - Fax:540-298-4077
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024041690363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health