Individual
MRS. LESLIE ANN TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1001 YORK RD, BALTIMORE, MD 21204-2516
(410) 923-1044
Mailing address
1404 COTTON CT, CROWNSVILLE, MD 21032-1924
(410) 923-1044
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R130790
MD
363LF0000X
Family Nurse Practitioner
Primary
R130790
MD
Other
Enumeration date
06/01/2005
Last updated
02/13/2009
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