Provider Demographics
NPI:1225425531
Name:DE LEON, MARIA LOURDES NOLASCO (BSN,RN)
Entity Type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:NOLASCO
Last Name:DE LEON
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LOURDES
Other - Last Name:NOLASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN,RN
Mailing Address - Street 1:6511 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1715
Mailing Address - Country:US
Mailing Address - Phone:612-701-3065
Mailing Address - Fax:
Practice Address - Street 1:6511 12TH AVE. S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:612-273-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR158384-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse