Individual
LESLIE ANN WALDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6610
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71009644A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71009644A
APRN
IN
01
—
71009644B
CSR-PRESCRIPTIVE AUTHORITY
IN
Enumeration date
12/26/2019
Last updated
08/30/2023
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