Healthcare Provider Details

I. General information

NPI: 1235215492
Provider Name (Legal Business Name): LESLIE ANN SERNA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE ANN RASMUSSON R.N.

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SIERRA ARMY DEPOT BUILDING 150
HERLONG CA
96113
US

IV. Provider business mailing address

1070 ASHLEY WAY
SUSANVILLE CA
96130-6013
US

V. Phone/Fax

Practice location:
  • Phone: 530-827-4141
  • Fax:
Mailing address:
  • Phone: 530-257-3781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number647092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: