Provider Demographics
NPI:1568420271
Name:FORSEEN, LEDA ESTRELLA (LPN)
Entity Type:Individual
Prefix:MS
First Name:LEDA
Middle Name:ESTRELLA
Last Name:FORSEEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LYNDA
Other - Middle Name:SUSAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1315 7TH STREET E.
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751
Mailing Address - Country:US
Mailing Address - Phone:952-567-1777
Mailing Address - Fax:
Practice Address - Street 1:N9562 COUNTY ROAD G
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WI
Practice Address - Zip Code:54730-4633
Practice Address - Country:US
Practice Address - Phone:612-605-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI301832-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38315000Medicaid