Provider Demographics
NPI:1225441041
Name:GESNER, LESLIE JEAN (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JEAN
Last Name:GESNER
Suffix:
Gender:F
Credentials:LM, CPM
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 276
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-0276
Mailing Address - Country:US
Mailing Address - Phone:360-224-8167
Mailing Address - Fax:
Practice Address - Street 1:411 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9525
Practice Address - Country:US
Practice Address - Phone:360-224-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000219176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife