Provider Demographics
NPI:1588828297
Name:LATHROP, LESLEY R (R N)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:R
Last Name:LATHROP
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 OAKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952
Mailing Address - Country:US
Mailing Address - Phone:920-738-7479
Mailing Address - Fax:
Practice Address - Street 1:1764 OAKRIDGE COURT
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952
Practice Address - Country:US
Practice Address - Phone:920-738-7479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62890-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse