Provider Demographics
NPI:1649806514
Name:RORICK, LESLEY PHILLIPS (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:PHILLIPS
Last Name:RORICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115A LA GRANGE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9592
Mailing Address - Country:US
Mailing Address - Phone:301-392-1935
Mailing Address - Fax:301-392-1936
Practice Address - Street 1:115A LA GRANGE AVE STE 101
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9592
Practice Address - Country:US
Practice Address - Phone:301-392-1935
Practice Address - Fax:301-392-1936
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR222502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily