Provider Demographics
NPI:1013482918
Name:REDMON, LESLIE YVONNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:YVONNE
Last Name:REDMON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 BALTIMORE DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3934
Mailing Address - Country:US
Mailing Address - Phone:616-454-4777
Mailing Address - Fax:
Practice Address - Street 1:470 BALTIMORE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3934
Practice Address - Country:US
Practice Address - Phone:616-454-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704345082163WC1500X, 163WP0809X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult