Provider Demographics
NPI:1710375613
Name:URBANCZYK, LESLIE (RNFA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:URBANCZYK
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 LUTHER LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5915
Mailing Address - Country:US
Mailing Address - Phone:806-674-0932
Mailing Address - Fax:
Practice Address - Street 1:6301 GASTON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3922
Practice Address - Country:US
Practice Address - Phone:972-707-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX559058163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical