Provider Demographics
NPI:1154788164
Name:BUSCH, LESLIE ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:BUSCH
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-6026
Mailing Address - Fax:866-936-4559
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:STE 3110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6026
Practice Address - Fax:866-936-4559
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015042829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420067980Medicaid