Individual
LESLIE K ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-108714
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114249901
TRICARE
AL
05
—
120355
—
AL
01
—
511-03149
BC BS OF AL
AL
Enumeration date
02/19/2010
Last updated
09/09/2013
Update your record
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