Provider Demographics
NPI:1356601488
Name:PITTS, LESLIE JO-ANN (RN)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JO-ANN
Last Name:PITTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14614 221ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3833
Mailing Address - Country:US
Mailing Address - Phone:718-926-3437
Mailing Address - Fax:718-527-8522
Practice Address - Street 1:70-24 47TH AVENUE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-476-7163
Practice Address - Fax:718-476-7051
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY452226-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse