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Individual
LESLIE D JANSA
Active
Individual
LESLIE D JANSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
312780501
—
TX
01
—
863N49
BCBS
TX
Enumeration date
10/31/2011
Last updated
08/08/2013
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