Healthcare Provider Details

I. General information

NPI: 1962811208
Provider Name (Legal Business Name): LESLIE PRESTENBACH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 MILLING AVE
LULING LA
70070-4442
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 985-307-1600
  • Fax: 504-575-3691
Mailing address:
  • Phone: 504-575-3712
  • Fax: 504-575-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO7977
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: