Provider Demographics
NPI:1740945740
Name:SECRIST, LESLIE SUSAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:LESLIE SUSAN
Middle Name:
Last Name:SECRIST
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 1:24130 VAN WEDDING RD
Mailing Address - Street 2:
Mailing Address - City:SUNMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47041-9476
Mailing Address - Country:US
Mailing Address - Phone:513-289-8153
Mailing Address - Fax:
Practice Address - Street 1:7300 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4119
Practice Address - Country:US
Practice Address - Phone:513-232-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily