Provider Demographics
NPI:1821820473
Name:REISNOUR, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:REISNOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3520 81ST AVE SE UNIT 18
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-9500
Mailing Address - Country:US
Mailing Address - Phone:701-320-2925
Mailing Address - Fax:
Practice Address - Street 1:814 17TH ST NE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2737
Practice Address - Country:US
Practice Address - Phone:701-320-8193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator