Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 28150640A | IN |
NPI | 1023426780 |
---|---|
Provider Name | Mrs. Lesli White |
First Address | Indianapolis, IN 46222-3271 |
Second Address | Indianapolis, IN 46222-3271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2014 |
Last Update Date | 25/07/2014 |