Healthcare Provider Details

I. General information

NPI: 1083545172
Provider Name (Legal Business Name): LESLE BROGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 UNION STATION PLZ
BETHLEHEM PA
18015-1281
US

IV. Provider business mailing address

1720 MINE LANE RD
EASTON PA
18045-5818
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2786
  • Fax:
Mailing address:
  • Phone: 835-267-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN619551
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: