Provider Demographics
NPI:1497115240
Name:LESHOURE, NICOLE ADELE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ADELE
Last Name:LESHOURE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 6TH AVE S FL 7
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1601
Mailing Address - Country:US
Mailing Address - Phone:205-407-5600
Mailing Address - Fax:205-407-5519
Practice Address - Street 1:1515 6TH AVE S FL 7
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-407-5600
Practice Address - Fax:205-407-5519
Is Sole Proprietor?:No
Enumeration Date:2016-03-06
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1138719363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care