Provider Demographics
NPI:1033244462
Name:FREE, LESLIE B (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:B
Last Name:FREE
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:4150 NELSON ROAD
Mailing Address - Street 2:BUILDING A SUITE 4
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4196
Mailing Address - Country:US
Mailing Address - Phone:337-478-2124
Mailing Address - Fax:337-477-7616
Practice Address - Street 1:4150 NELSON ROAD
Practice Address - Street 2:A-4
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4196
Practice Address - Country:US
Practice Address - Phone:337-478-2124
Practice Address - Fax:337-477-7616
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2011-04-04
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Provider Licenses
StateLicense IDTaxonomies
LA01329367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1393614Medicaid
LA1393614Medicaid