Provider Demographics
NPI:1366886103
Name:HABEGGER, LESLIE MICHAELENE (CNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHAELENE
Last Name:HABEGGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-2681
Mailing Address - Country:US
Mailing Address - Phone:419-698-9745
Mailing Address - Fax:
Practice Address - Street 1:1 SEAGATE STE 1960
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1522
Practice Address - Country:US
Practice Address - Phone:419-247-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 06965-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily