Provider Demographics
NPI:1255804555
Name:MATHEWS, LESLEY N
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:N
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 RANDOLPH PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1125
Mailing Address - Country:US
Mailing Address - Phone:310-531-3762
Mailing Address - Fax:
Practice Address - Street 1:635 EDGEWOOD ST NE APT 718
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4133
Practice Address - Country:US
Practice Address - Phone:202-722-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty