Healthcare Provider Details

I. General information

NPI: 1386955813
Provider Name (Legal Business Name): LESLIE KIRSTEN FORD RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD LOUIS STOKES CLEVELAND VA MEDICAL CENTER
CLEVELAND OH
44106
US

IV. Provider business mailing address

22136 MACBETH AVE
FAIRVIEW PARK OH
44126-2964
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 440-779-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.359984
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: