Individual
LESLIE HENRY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 N RANGE AVE STE D, DENHAM SPRINGS, LA 70726-2428
(225) 667-4999
(225) 667-4998
Mailing address
1211 N RANGE AVE STE D, DENHAM SPRINGS, LA 70726-2428
(225) 667-4999
(225) 667-4998
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
15462
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
463446046
—
LA
Enumeration date
09/04/2018
Last updated
09/04/2018
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