Provider Demographics
NPI:1760561328
Name:KLUG, LESLEY K (APRN)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:K
Last Name:KLUG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241573
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2346
Mailing Address - Country:US
Mailing Address - Phone:402-393-3110
Mailing Address - Fax:402-398-4499
Practice Address - Street 1:17201 WRIGHT ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2042
Practice Address - Country:US
Practice Address - Phone:402-334-4773
Practice Address - Fax:402-334-7463
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP8436363LA2100X
NE111976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA454770OtherREGISTERED NURSE
CAFO002ZMedicare PIN