Provider Demographics
NPI:1922866433
Name:ELDER, LESLIE MARIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:ELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33305 1ST WAY S STE B102
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4545
Mailing Address - Country:US
Mailing Address - Phone:425-615-1940
Mailing Address - Fax:
Practice Address - Street 1:33305 1ST WAY S STE B102
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4545
Practice Address - Country:US
Practice Address - Phone:425-615-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00106581163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management