Provider Demographics
NPI:1245435460
Name:HOOPER, LESLEY
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:
Last Name:HOOPER
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 1:307 HARKINS ROAD
Mailing Address - Street 2:PO BOX 172
Mailing Address - City:RYEGATE
Mailing Address - State:MT
Mailing Address - Zip Code:59074
Mailing Address - Country:US
Mailing Address - Phone:406-568-2252
Mailing Address - Fax:
Practice Address - Street 1:307 HARKINS
Practice Address - Street 2:BOX 172
Practice Address - City:RYEGATE
Practice Address - State:MT
Practice Address - Zip Code:59074
Practice Address - Country:US
Practice Address - Phone:406-568-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide