Provider Demographics
NPI:1609179019
Name:LEESE, MICHELE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:LEESE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 NE COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63360 NW BRITTA ST.
Practice Address - Street 2:STE. 1
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9475
Practice Address - Country:US
Practice Address - Phone:541-322-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201042404163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health