Healthcare Provider Details

I. General information

NPI: 1861535171
Provider Name (Legal Business Name): LESLIE LYN BIDWELL CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 VANN AVE
EVANSVILLE IN
47714-3359
US

IV. Provider business mailing address

1550 VANN AVE
EVANSVILLE IN
47714-3359
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-1366
  • Fax: 812-469-7438
Mailing address:
  • Phone: 812-482-1366
  • Fax: 812-469-7438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number67000087A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: