Provider Demographics
NPI:1144374125
Name:EVERS, LESLIE M (RN, CS)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:M
Last Name:EVERS
Suffix:
Gender:F
Credentials:RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3629
Mailing Address - Country:US
Mailing Address - Phone:703-549-3881
Mailing Address - Fax:703-549-2427
Practice Address - Street 1:401 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3629
Practice Address - Country:US
Practice Address - Phone:703-549-3881
Practice Address - Fax:703-549-2427
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001104126106H00000X, 163WP0807X, 163WP0808X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001104126OtherSTATE LICENSE NUMBER