Healthcare Provider Details

I. General information

NPI: 1154491223
Provider Name (Legal Business Name): LESLIE ANN VELA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 W COTA DR
BLOOMINGTON IN
47403-4217
US

IV. Provider business mailing address

PO BOX 5637
BLOOMINGTON IN
47407-5637
US

V. Phone/Fax

Practice location:
  • Phone: 812-337-0210
  • Fax: 812-337-0211
Mailing address:
  • Phone: 812-337-5003
  • Fax: 812-337-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000976A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: