Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 31600 | WI |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO28866 | OR |
N | 207Q00000X | Family Doctor | D028866 | OR |
NPI | 1063590909 |
---|---|
Provider Name | Sandra Lee Sleszynski |
First Address | Corvallis, OR 97333 |
Second Address | Corvallis, OR 97333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 24/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F53549 | (02) | WI |