Provider Demographics
NPI:1053600221
Name:WHITE, LESLIE A (LPN)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 NORTH AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-2346
Mailing Address - Country:US
Mailing Address - Phone:203-368-9243
Mailing Address - Fax:203-334-0175
Practice Address - Street 1:2340 NORTH AVE APT 3C
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-2346
Practice Address - Country:US
Practice Address - Phone:203-368-9243
Practice Address - Fax:203-334-0175
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024115164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse