Individual
LESLE SPAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
743 SOUTH AVE, BRIDGEPORT, CT 06604-5810
(203) 330-6000
(203) 330-6013
Mailing address
46 ALBION STREET, BRIDGEPORT, CT 06605-2605
(203) 332-3155
(203) 330-6013
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R31784
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236130
—
CT
Enumeration date
08/12/2008
Last updated
06/12/2017
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