Healthcare Provider Details

I. General information

NPI: 1750961132
Provider Name (Legal Business Name): LESLIE CAROL CASACHAHUA SIESQUEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TOWN CENTER BLVD STE 400
JARRELL TX
76537-4007
US

IV. Provider business mailing address

1750 TIMBER RIDGE RD APT 118
AUSTIN TX
78741-5574
US

V. Phone/Fax

Practice location:
  • Phone: 512-588-1501
  • Fax:
Mailing address:
  • Phone: 207-712-0962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1033714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: