Provider Demographics
NPI:1356875397
Name:STEGALL, LESLIE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:STEGALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1369
Mailing Address - Country:US
Mailing Address - Phone:740-403-9108
Mailing Address - Fax:937-462-1385
Practice Address - Street 1:330 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1369
Practice Address - Country:US
Practice Address - Phone:740-403-9108
Practice Address - Fax:937-462-1385
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020690363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily