Provider Demographics
NPI:1942486543
Name:MCMAHON, LESLEY RENEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:RENEE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:RENEE
Other - Last Name:MCBEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:2600 SIXTH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-456-2695
Mailing Address - Fax:
Practice Address - Street 1:6100 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7618
Practice Address - Country:US
Practice Address - Phone:330-305-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily