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General NPI Number Information
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NPI Number | 1639643687
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Entity Type | Individual
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Provider Name | LESLEY RAE HAUCK RN
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Gender | Female
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Dates
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Enumeration Date | 01/13/2019
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Last Update Date | 01/13/2019
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Provider Practice Location Address
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Address Line | 5301 SUGARLOAF TRL # 5208
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City | FORT WORTH
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State | TX
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Zip | 76244-1437
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Country | US
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Telephone | 703-593-2619
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Fax |
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Provider Business Mailing Address
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Address Line | 750 S MAIN ST STE 150-54
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City | KELLER
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State | TX
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Zip | 76248-7043
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Country | US
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Telephone | 703-593-2619
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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