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General NPI Number Information
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NPI Number | 1215645254
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Entity Type | Individual
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Provider Name | NICOLE LESHKO PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 1000 ALLIANCE DR STE 10
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City | HAZLETON
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State | PA
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Zip | 18202-3234
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Country | US
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Telephone | 570-501-6450
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Fax |
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Provider Business Mailing Address
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Address Line | 11 WALSH ST
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City | MCADOO
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State | PA
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Zip | 18237-3147
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Country | US
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Telephone | 570-956-5332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA064168
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License Number State | PA
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