Provider Demographics
NPI:1336481233
Name:FLEMISTER, LEILANI FRANCELLA
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:FRANCELLA
Last Name:FLEMISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 LAKELAND AVE N
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2986
Mailing Address - Country:US
Mailing Address - Phone:763-225-7396
Mailing Address - Fax:
Practice Address - Street 1:6248 LAKELAND AVE N
Practice Address - Street 2:SUITE 211
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55428-2986
Practice Address - Country:US
Practice Address - Phone:763-225-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 062286-0164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse