Individual
LESLIE ROMERSBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 844-5343
Mailing address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003656
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
833230
MEDICARE GROUP #
—
Enumeration date
11/05/2009
Last updated
01/14/2010
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