Provider Demographics
NPI:1235215492
Name:SERNA, LESLIE ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:SERNA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:RASMUSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1070 ASHLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-6013
Mailing Address - Country:US
Mailing Address - Phone:530-257-3781
Mailing Address - Fax:
Practice Address - Street 1:SIERRA ARMY DEPOT
Practice Address - Street 2:BUILDING 150
Practice Address - City:HERLONG
Practice Address - State:CA
Practice Address - Zip Code:96113
Practice Address - Country:US
Practice Address - Phone:530-827-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA647092163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse