Provider Demographics
NPI:1073549366
Name:ANSELL, LESA G (DC, RN, AGNP-C)
Entity Type:Individual
Prefix:DR
First Name:LESA
Middle Name:G
Last Name:ANSELL
Suffix:
Gender:F
Credentials:DC, RN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W BELT LINE RD
Mailing Address - Street 2:STE A
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1105
Mailing Address - Country:US
Mailing Address - Phone:972-291-1992
Mailing Address - Fax:
Practice Address - Street 1:214 W BELT LINE RD
Practice Address - Street 2:STE A
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1105
Practice Address - Country:US
Practice Address - Phone:972-291-1992
Practice Address - Fax:972-291-1163
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131295363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU87566Medicare UPIN
TX609599Medicare ID - Type Unspecified