Provider Demographics
NPI:1235354572
Name:WOLF, LESLIE M (APRN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:WOLF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8901 INDIAN HILLS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4057
Mailing Address - Country:US
Mailing Address - Phone:402-397-7057
Mailing Address - Fax:402-397-6656
Practice Address - Street 1:8901 INDIAN HILLS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4057
Practice Address - Country:US
Practice Address - Phone:402-397-7057
Practice Address - Fax:402-397-6656
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE110793363L00000X
IAA116276363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077295213Medicaid
NE098021002Medicare PIN