Healthcare Provider Details

I. General information

NPI: 1417513334
Provider Name (Legal Business Name): ALLISON NICOLE LESKO RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12134 TRENTMORE PL
SAINT LOUIS MO
63127-1407
US

IV. Provider business mailing address

12134 TRENTMORE PL
SAINT LOUIS MO
63127-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-306-6837
  • Fax:
Mailing address:
  • Phone: 314-306-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number86041656
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86041656
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86041656
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: