Provider Demographics
NPI:1326214669
Name:CAMACHO, LESLYN ALISON (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LESLYN
Middle Name:ALISON
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5702
Mailing Address - Country:US
Mailing Address - Phone:718-629-1235
Mailing Address - Fax:718-451-3769
Practice Address - Street 1:506 E 42ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5702
Practice Address - Country:US
Practice Address - Phone:718-629-1235
Practice Address - Fax:718-451-3769
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257214164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01900467Medicaid