Provider Demographics
NPI:1396348678
Name:WEISENBERGER, LESLIE GAIL
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:GAIL
Last Name:WEISENBERGER
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 1:14642 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48649-9786
Mailing Address - Country:US
Mailing Address - Phone:989-494-3012
Mailing Address - Fax:
Practice Address - Street 1:14642 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:MI
Practice Address - Zip Code:48649-9786
Practice Address - Country:US
Practice Address - Phone:989-494-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704257368363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily