Provider Demographics
NPI:1154491223
Name:VELA, LESLIE ANN (NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:VELA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5637
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-5637
Mailing Address - Country:US
Mailing Address - Phone:812-337-5003
Mailing Address - Fax:812-337-5010
Practice Address - Street 1:2499 W COTA DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4217
Practice Address - Country:US
Practice Address - Phone:812-337-0210
Practice Address - Fax:812-337-0211
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000976A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200859380CMedicaid
IN200859380FMedicaid
IN200859380JMedicaid
IN200859380AMedicaid
INM400026190Medicare PIN
IN200859380FMedicaid
IN200859380AMedicaid
IN200859380CMedicaid