Provider Demographics
NPI:1972120178
Name:PRITT, LESLIE A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:PRITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ROYAL CREST DR UNIT L
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9743
Mailing Address - Country:US
Mailing Address - Phone:330-466-2439
Mailing Address - Fax:
Practice Address - Street 1:132 ROYAL CREST DR UNIT L
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9743
Practice Address - Country:US
Practice Address - Phone:330-466-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse