Healthcare Provider Details

I. General information

NPI: 1053732347
Provider Name (Legal Business Name): LESLEY NELSON LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 10TH ST
DAVIS CA
95616-2282
US

IV. Provider business mailing address

814 10TH ST
DAVIS CA
95616-2282
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-9609
  • Fax: 530-753-6142
Mailing address:
  • Phone: 530-750-9609
  • Fax: 530-753-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: