Provider Demographics
NPI:1295339489
Name:LESISKO, DYLAN (CRNP)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:LESISKO
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SHIMER AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-4646
Mailing Address - Country:US
Mailing Address - Phone:570-778-0421
Mailing Address - Fax:
Practice Address - Street 1:619 DALTON ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-3031
Practice Address - Country:US
Practice Address - Phone:610-628-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANPPA043085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily