Provider Demographics
NPI:1871522755
Name:FEHAN, LESLIE (CNM)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:FEHAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:GIBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:13700 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 606
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3222
Mailing Address - Country:US
Mailing Address - Phone:804-423-8462
Mailing Address - Fax:804-423-8463
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 606
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-423-8462
Practice Address - Fax:804-423-8463
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024097930367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA418654OtherSOUTHERN HEALTH SERVICES
VA1216508OtherAETNA HMO
VA010261821Medicaid
VA7944408OtherAETNA LIFE
VAP06447Medicare UPIN