Provider Demographics
NPI:1518127091
Name:DICKSON, LESLIE AUGUSTUS (LPN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:AUGUSTUS
Last Name:DICKSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5638
Mailing Address - Country:US
Mailing Address - Phone:347-789-8474
Mailing Address - Fax:
Practice Address - Street 1:1374 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5638
Practice Address - Country:US
Practice Address - Phone:347-789-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287359-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse