Provider Demographics
NPI:1760458236
Name:HENSLEY, LESLIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BOYD CIR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6219
Mailing Address - Country:US
Mailing Address - Phone:302-697-2468
Mailing Address - Fax:
Practice Address - Street 1:100 SCULL TERRACE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-346-3171
Practice Address - Fax:302-346-3178
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL60A00209367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
001340K95Medicare ID - Type Unspecified