Individual
LESLIE A NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3901 W 25TH ST, SAINT LOUIS PARK, MN 55416-3803
(612) 374-0177
(612) 374-0893
Mailing address
3901 W 25TH ST, SAINT LOUIS PARK, MN 55416-3803
(612) 374-0177
(612) 374-0893
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
40344
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261S8SE
BCBS MN
MN
Enumeration date
03/02/2006
Last updated
03/27/2008
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