Provider Demographics
NPI:1750961132
Name:CASACHAHUA SIESQUEN, LESLIE CAROL (FNP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:CAROL
Last Name:CASACHAHUA SIESQUEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 TIMBER RIDGE RD APT 118
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-5574
Mailing Address - Country:US
Mailing Address - Phone:207-712-0962
Mailing Address - Fax:
Practice Address - Street 1:180 TOWN CENTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-4007
Practice Address - Country:US
Practice Address - Phone:512-588-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily