Individual
LESLIE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 SANSOM ST, SUITE 239, PHILADELPHIA, PA 19107-5002
(215) 955-6844
Mailing address
1020 SANSOM ST, SUITE 239, PHILADELPHIA, PA 19107-5002
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP016987
PA
Other
Enumeration date
12/08/2016
Last updated
04/20/2017
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