Provider Demographics
NPI:1265019020
Name:LAINE, LESLIE (RN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LAINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:LUTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1519 LOVELY LN
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7601
Mailing Address - Country:US
Mailing Address - Phone:562-446-6070
Mailing Address - Fax:
Practice Address - Street 1:2185 CITRACADO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4159
Practice Address - Country:US
Practice Address - Phone:760-881-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95198633163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health