Healthcare Provider Details

I. General information

NPI: 1962806521
Provider Name (Legal Business Name): LESLEE HEUER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLEE BAUMANN

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E PINE ST
EXETER CA
93221-1838
US

IV. Provider business mailing address

111 S CORNUCOPIA RD
EXETER CA
93221-9613
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-2134
  • Fax:
Mailing address:
  • Phone: 559-246-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95001380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: