Healthcare Provider Details

I. General information

NPI: 1881169274
Provider Name (Legal Business Name): LESLIE ANN GLEAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 CURTIS AVE
OMAHA NE
68111-1169
US

IV. Provider business mailing address

3775 CURTIS AVE
OMAHA NE
68111-1169
US

V. Phone/Fax

Practice location:
  • Phone: 402-457-6630
  • Fax:
Mailing address:
  • Phone: 402-881-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number077941
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: