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General NPI Number Information
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NPI Number | 1750961132
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Entity Type | Individual
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Provider Name | LESLIE CAROL CASACHAHUA SIESQUEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/10/2021
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 180 TOWN CENTER BLVD STE 400
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City | JARRELL
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State | TX
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Zip | 76537-4007
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Country | US
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Telephone | 512-588-1501
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 TIMBER RIDGE RD APT 118
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City | AUSTIN
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State | TX
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Zip | 78741-5574
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Country | US
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Telephone | 207-712-0962
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1033714
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License Number State | TX
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