Provider Demographics
NPI:1750687455
Name:GREGG, LESLIE MARIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:GREGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:GREGG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:12721 E SHANNON AVE
Mailing Address - Street 2:APT. 107
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1651
Mailing Address - Country:US
Mailing Address - Phone:509-432-3130
Mailing Address - Fax:
Practice Address - Street 1:12721 E SHANNON AVE
Practice Address - Street 2:APT. 107
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1651
Practice Address - Country:US
Practice Address - Phone:509-432-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60199151163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN 60199151OtherRN LISCENSE