Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 310278 | LA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101020876 | MI |
NPI | 1689085490 |
---|---|
Provider Name | Lauren Justine Leslie |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 01/10/2018 |