=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730131822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN LOUISE LESCH N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 N LAFAYETTE BLVD
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46601-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-232-2037
-----------------------------------------------------
Fax | 574-232-1420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 N LAFAYETTE BLVD
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46601-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-232-2037
-----------------------------------------------------
Fax | 574-232-1420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 71000063A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------