Provider Demographics
NPI:1780870915
Name:NANCE, LESLIE JANE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JANE
Last Name:NANCE
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 1:11760 SAN PABLO AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1777
Mailing Address - Country:US
Mailing Address - Phone:510-417-1331
Mailing Address - Fax:
Practice Address - Street 1:11760 SAN PABLO AVE APT 105
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1777
Practice Address - Country:US
Practice Address - Phone:510-417-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program