Individual
LESLIE LEE BREIDENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
1330 GROVE AVE, RACINE, WI 53405-3045
(262) 633-4548
Mailing address
1330 GROVE AVE, RACINE, WI 53405-3045
(262) 633-4548
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
28104-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38317300
—
WI
Enumeration date
02/28/2007
Last updated
07/09/2007
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