Provider Demographics
NPI:1295724227
Name:MATHEWS, LESLEY ANN (MSN FNPC)
Entity type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:ANN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MSN FNPC
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:MATHEWS
Other - Last Name:HILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:207 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5810
Mailing Address - Country:US
Mailing Address - Phone:210-326-6389
Mailing Address - Fax:
Practice Address - Street 1:22 S. GREENE ST
Practice Address - Street 2:GREENEBAUM CANCER CENTER, STE 9-D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211676363L00000X
TX533575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177644504Medicaid
TX8L14256Medicare PIN