Healthcare Provider Details

I. General information

NPI: 1912067174
Provider Name (Legal Business Name): LESLIE ERNEST HINSHAW M.S., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALBUQUERQUE AREA INDIAN HEALTH BOARD, INC 5015 PROSPECT AVE NE
ALBUQUERQUE NM
87110-4045
US

IV. Provider business mailing address

ALBUQUERQUE AREA INDIAN HEALTH BOARD, INC 5015 PROSPECT AVE NE
ALBUQUERQUE NM
87110-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-0036
  • Fax: 505-764-0446
Mailing address:
  • Phone: 505-764-0036
  • Fax: 505-764-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2451
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number396
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: