Healthcare Provider Details

I. General information

NPI: 1679912695
Provider Name (Legal Business Name): LESLIE LYNN CLASON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S BALLENGER HWY 3 NORTH
FLINT MI
48532-3638
US

IV. Provider business mailing address

401 S BALLENGER HWY 3 NORTH
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-2503
  • Fax: 810-342-2503
Mailing address:
  • Phone: 810-342-2503
  • Fax: 810-342-2591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704257149
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704257149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: