Provider Demographics
NPI:1619209699
Name:HARRIS, LESLIE ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3450
Mailing Address - Country:US
Mailing Address - Phone:845-514-2410
Mailing Address - Fax:845-514-2820
Practice Address - Street 1:728 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3450
Practice Address - Country:US
Practice Address - Phone:845-514-2410
Practice Address - Fax:845-514-2820
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249508-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse