Provider Demographics
NPI:1053645143
Name:LANDON, LESA ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:ANNE
Last Name:LANDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICHOLE
Other - Last Name:LANDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:30433 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:OK
Mailing Address - Zip Code:74331-8427
Mailing Address - Country:US
Mailing Address - Phone:918-944-3442
Mailing Address - Fax:
Practice Address - Street 1:63153 EAST 290 ROAD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74345
Practice Address - Country:US
Practice Address - Phone:918-944-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL 0053409164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse