Individual
LESLIE ANN WEISS RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Mailing address
1700 W PARADISE DRIVE, WEST BEND, WI 53095-9795
(262) 334-3451
(262) 334-5321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
WI
Other
Enumeration date
07/10/2017
Last updated
04/15/2019
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