Individual
LESLEY MARTIN-MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1 WYOMING ST, DAYTON, OH 45409-2722
(937) 208-4380
Mailing address
1 WYOMING ST, DAYTON, OH 45409-2722
(937) 208-4380
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA 12748
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COA 12748
CRNA LICENSE
OH
01
—
RN307074
RN LICENSE
OH
Enumeration date
10/04/2011
Last updated
09/25/2014
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