Provider Demographics
NPI:1073530721
Name:SHINPOCH, LESLIE BROOKS (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:BROOKS
Last Name:SHINPOCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5540
Mailing Address - Country:US
Mailing Address - Phone:318-742-2638
Mailing Address - Fax:318-795-9155
Practice Address - Street 1:1400 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5603
Practice Address - Country:US
Practice Address - Phone:318-795-0425
Practice Address - Fax:318-795-9155
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA033127163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse