Provider Demographics
NPI:1205509726
Name:METTS, LESLEY AMBER (MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:AMBER
Last Name:METTS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16588 S 250 W
Mailing Address - Street 2:
Mailing Address - City:HANNA
Mailing Address - State:IN
Mailing Address - Zip Code:46340-9753
Mailing Address - Country:US
Mailing Address - Phone:219-851-9340
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH PARK AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4810
Practice Address - Country:US
Practice Address - Phone:574-364-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28170265A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse