Healthcare Provider Details

I. General information

NPI: 1134491764
Provider Name (Legal Business Name): MS. LESLEE KAY OREBAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 PARSONS AVE
ANCHORAGE AK
99508-1216
US

IV. Provider business mailing address

PO BOX 242423
ANCHORAGE AK
99524-2423
US

V. Phone/Fax

Practice location:
  • Phone: 907-360-1163
  • Fax:
Mailing address:
  • Phone: 907-360-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number360595
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: