MEDICARE: LESLE SPAIN

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
1	363LF0000X	Family Nurse Practitioner	R31784	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740436674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLE SPAIN

Provider Business Mailing Address
First Line	:	46 ALBION STREET
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06605-2605
Country	:	US
Telephone Number	:	203-332-3155
Fax Number	:	203-330-6013

Provider Business Practice Location Address
First Line	:	743 SOUTH AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-5810
Country	:	US
Telephone Number	:	203-330-6000
Fax Number	:	203-330-6013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	06/12/2017

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Directions to “ LESLE SPAIN ” Practice Location

Language	Start Address	Practice Location

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