Healthcare Provider Details

I. General information

NPI: 1255047528
Provider Name (Legal Business Name): LESLIE ERIN EISCHEID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CLARK ST STE 275
CARROLL IA
51401-3086
US

IV. Provider business mailing address

22315 HAWTHORNE AVE
CARROLL IA
51401-8992
US

V. Phone/Fax

Practice location:
  • Phone: 712-794-6780
  • Fax: 515-274-7245
Mailing address:
  • Phone: 712-579-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number114272
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: