Provider Demographics
NPI:1467881730
Name:FEESER, LESA Z
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:Z
Last Name:FEESER
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 1:8181 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2555
Mailing Address - Country:US
Mailing Address - Phone:317-201-4657
Mailing Address - Fax:
Practice Address - Street 1:8181 JORDAN LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2555
Practice Address - Country:US
Practice Address - Phone:317-201-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN347127343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)