Provider Demographics
NPI:1730440272
Name:LESHER, MICHELLE RAE-MARY (RN, RD, LN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RAE-MARY
Last Name:LESHER
Suffix:
Gender:F
Credentials:RN, RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13815 BATTLE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMOSA
Mailing Address - State:SD
Mailing Address - Zip Code:57744-0019
Mailing Address - Country:US
Mailing Address - Phone:605-255-4101
Mailing Address - Fax:605-255-4687
Practice Address - Street 1:13815 BATTLE CREEK ROAD
Practice Address - Street 2:
Practice Address - City:HERMOSA
Practice Address - State:SD
Practice Address - Zip Code:57744-0019
Practice Address - Country:US
Practice Address - Phone:605-255-4101
Practice Address - Fax:605-255-4687
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0374133N00000X
SD1003750133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist