Provider Demographics
NPI:1689905317
Name:CHIRDON, LESLIE DAWN (LPN)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DAWN
Last Name:CHIRDON
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 1:464 COVEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1108
Mailing Address - Country:US
Mailing Address - Phone:585-755-4800
Mailing Address - Fax:
Practice Address - Street 1:464 COVEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1108
Practice Address - Country:US
Practice Address - Phone:585-755-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300032164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse