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NPI Code Detail

MEDICARE: LESLIE DEMO

MEDICARE: LESLIE DEMO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1467854851
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE DEMO
Provider Business Mailing Address
First Line : 520 E AUGUSTA AVE
Second Line :
City : AUGUSTA
State : KS
Zip : 67010-2100
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 450 N 159TH ST E
Second Line :
City : WICHITA
State : KS
Zip : 67230-7704
Country : US
Telephone Number : 316-440-1312
Fax Number : 316-440-1318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2014
Last Update Date : 09/17/2014

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1841692639 — ELIZABETH CASANOVA
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WICHITA, KS
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1912309782 — CASSANDRA STULL
Practice Location Address:
450 N 159TH ST E
WICHITA, KS
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Directions to “ LESLIE DEMO ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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