Provider Demographics
NPI:1053732347
Name:NELSON, LESLEY (LM, CPM)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2282
Mailing Address - Country:US
Mailing Address - Phone:530-750-9609
Mailing Address - Fax:530-753-6142
Practice Address - Street 1:814 10TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2282
Practice Address - Country:US
Practice Address - Phone:530-750-9609
Practice Address - Fax:530-753-6142
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0373176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife