Basic Information
| Provider Information | |||||||||
| NPI: | 1770716938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLACK | ||||||||
| FirstName: | LEIGH-ANNE | ||||||||
| MiddleName: | LINDENMUTH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2817 REILLY ROAD | ||||||||
| Address2: | MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2817 REILLY ROAD | ||||||||
| Address2: | MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2009 | ||||||||
| LastUpdateDate: | 03/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0102202732 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 192120 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 192120 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 0102202732 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.