Individual
MS. LESLIE A. WIZAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
12198 MANTAWAUKA DR, FENTON, MI 48430-8853
(810) 996-4775
Mailing address
12198 MANTAWAUKA DR, FENTON, MI 48430-8853
(810) 964-7756
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
106426
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B56166
BLUE SHIELD
MI
05
—
101850691
—
MI
Enumeration date
08/11/2006
Last updated
04/08/2014
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