Provider Demographics
NPI:1568416741
Name:LESSEIG, DELORES Z (APRN)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:Z
Last Name:LESSEIG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CROWN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2510
Mailing Address - Country:US
Mailing Address - Phone:660-665-7500
Mailing Address - Fax:660-665-7546
Practice Address - Street 1:1 CROWN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2510
Practice Address - Country:US
Practice Address - Phone:660-665-7500
Practice Address - Fax:660-665-7546
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN 044415363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
264204OtherCOMMERCIAL
MO108439OtherBLUE CROSS/BLUE SHIELD
264204OtherCOMMERCIAL