Provider Demographics
NPI:1700258670
Name:EZDEBSKI, LESLIE HAHN (RN)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:HAHN
Last Name:EZDEBSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:SUSAN
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:318 RIVER ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49431
Mailing Address - Country:US
Mailing Address - Phone:231-723-4181
Mailing Address - Fax:231-723-7780
Practice Address - Street 1:318 RIVER ST.
Practice Address - Street 2:SUITE B
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49431
Practice Address - Country:US
Practice Address - Phone:231-723-4181
Practice Address - Fax:231-723-7780
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704149223163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health