Individual
ANGELIQUE MARIE LEIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3103 BRECKENRIDGE LN STE 1, LOUISVILLE, KY 40220
(501) 495-5055
(502) 495-5057
Mailing address
3103 BRECKENRIDGE LN STE 1, LOUISVILLE, KY 40220-2798
(501) 495-5055
(502) 495-5057
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1146850
KY
363LF0000X
Family Nurse Practitioner
Primary
3012004
KY
Other
Enumeration date
01/10/2018
Last updated
11/27/2023
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