Provider Demographics
NPI:1275174922
Name:LAS, LESLIE ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:LAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:NELDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:500 EAST VETERANS STREET
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660
Mailing Address - Country:US
Mailing Address - Phone:608-372-3971
Mailing Address - Fax:608-371-1692
Practice Address - Street 1:500 EAST VETERANS STREET
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:608-371-1692
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9582-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner