Provider Demographics
NPI:1609118603
Name:LESHER HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:LESHER HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LESHER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:575-234-1234
Mailing Address - Street 1:PO BOX 3116
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-3116
Mailing Address - Country:US
Mailing Address - Phone:575-234-1234
Mailing Address - Fax:575-234-1640
Practice Address - Street 1:314 W MERMOD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5749
Practice Address - Country:US
Practice Address - Phone:575-234-1234
Practice Address - Fax:575-234-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty