Provider Demographics
NPI:1215208756
Name:BREW, LESLIE A
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:BREW
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:BREW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:122 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-1017
Mailing Address - Country:US
Mailing Address - Phone:585-465-1849
Mailing Address - Fax:
Practice Address - Street 1:122 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532-1017
Practice Address - Country:US
Practice Address - Phone:585-465-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10280717164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse