Healthcare Provider Details

I. General information

NPI: 1689309338
Provider Name (Legal Business Name): LESLIE DIANE YOCOM RN, LCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3230 BEECHER RD STE 1
FLINT MI
48532-3604
US

IV. Provider business mailing address

G3230 BEECHER RD STE 1
FLINT MI
48532-3604
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-5656
  • Fax: 810-342-5600
Mailing address:
  • Phone: 810-342-5656
  • Fax: 810-342-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number4704247953
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number4704247953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: