Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | C91245 | NC |
NPI | 1265848899 |
---|---|
Provider Name | Leslie Alston |
First Address | High Point, NC 27263-2363 |
Second Address | Greensboro, NC 27405-7014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 03/07/2014 |