Healthcare Provider Details

I. General information

NPI: 1477156263
Provider Name (Legal Business Name): LESLIE ALEX LOPOSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75082-3566
US

IV. Provider business mailing address

2241 HARTLINE DR
DALLAS TX
75228-3340
US

V. Phone/Fax

Practice location:
  • Phone: 972-470-5000
  • Fax:
Mailing address:
  • Phone: 972-978-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1003192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: