Provider Demographics
NPI:1689400111
Name:STAHLNECKER, LESLIE EARL (RN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:EARL
Last Name:STAHLNECKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 RUSSET RD
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8254
Mailing Address - Country:US
Mailing Address - Phone:509-200-2460
Mailing Address - Fax:
Practice Address - Street 1:3924 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2775
Practice Address - Country:US
Practice Address - Phone:509-492-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00130092163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool