Healthcare Provider Details

I. General information

NPI: 1033617980
Provider Name (Legal Business Name): ARIN BESSE LEIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 LAPEER AVE APT 2
PORT HURON MI
48060-4277
US

IV. Provider business mailing address

529 MLK BLVD
FLINT MI
48502
US

V. Phone/Fax

Practice location:
  • Phone: 810-858-8666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: