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General NPI Number Information
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NPI Number | 1740155399
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Entity Type | Organization
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Legal Business Name | LUCENA 2 LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1000 W NIFONG BLVD BLDG 2 SUITE 120 ROOM 2
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City | COLUMBIA
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State | MO
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Zip | 65203-5615
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Country | US
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Telephone | 573-444-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 PHEASANT RUN
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City | COLUMBIA
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State | MO
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Zip | 65201-6253
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | LESLIE DESHA
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Credential | FNP
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Telephone | 573-690-3976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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