Provider Demographics
NPI:1508446055
Name:LENARD, LESLIE A
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:LENARD
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 1:6045 MOJAVE DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3544
Mailing Address - Country:US
Mailing Address - Phone:469-819-1678
Mailing Address - Fax:
Practice Address - Street 1:3201 IH 30 STE Q1
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2678
Practice Address - Country:US
Practice Address - Phone:469-819-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant