Provider Demographics
NPI:1548278237
Name:LESLIE, PAMELA JO (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JO
Last Name:LESLIE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3847 PINE GROVE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4265
Mailing Address - Country:US
Mailing Address - Phone:810-966-3730
Mailing Address - Fax:810-985-7350
Practice Address - Street 1:3847 PINE GROVE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4265
Practice Address - Country:US
Practice Address - Phone:810-966-3730
Practice Address - Fax:810-985-7350
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704185844163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult