Individual
CHARLES J LEISTNER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
776 E 1485 RD, LAWRENCE, KS 66046-9265
(785) 917-1866
Mailing address
776 E 1485 RD, LAWRENCE, KS 66046-9265
(785) 917-1866
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-79245-121
KS
Other
Enumeration date
01/26/2020
Last updated
01/26/2020
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