Individual
LESLIE NICOLE KANIUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6913 N MAIN ST STE 100, GRANGER, IN 46530-8039
(574) 647-8542
(574) 647-8549
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-6592
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71016046A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300101596
—
IN
Enumeration date
09/03/2024
Last updated
02/03/2025
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