Provider Demographics
NPI:1831232644
Name:COPELAND, LESLIE ANN (MED, ARNP-BC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MED, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BUFFALO DANCE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8551
Mailing Address - Country:US
Mailing Address - Phone:513-777-9823
Mailing Address - Fax:
Practice Address - Street 1:260 NORTHLAND BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4917
Practice Address - Country:US
Practice Address - Phone:513-254-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-299888163WP0808X
KYRN-1039605163WP0808X
OHNS-06863364SP0808X
OH0211363-01364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCONS03011Medicare ID - Type UnspecifiedOHIO MEDICARE