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Individual

LESLIE ANNE EDGAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
11143 PARKVIEW PLAZA DR STE 100, FORT WAYNE, IN 46845
(260) 484-8830
Mailing address
11143 PARKVIEW PLAZA DR STE 100, FORT WAYNE, IN 46845-1728
(260) 484-8830

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000452A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000526346
ANTHEM PIN
IN
05
200956210
IN
05
3046162
OH
Enumeration date
05/08/2006
Last updated
07/12/2018
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