Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 53-77726-081 | KS |
NPI | 1255851309 |
---|---|
Provider Name | Leslie Suzanne Domsch |
First Address | Lenexa, KS 66227-2404 |
Second Address | Overland Park, KS 66215-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 30/10/2018 |