Provider Demographics
NPI:1003790262
Name:POHL, LESLIE NICOLE (BAN, RN, PHN, SANE)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:NICOLE
Last Name:POHL
Suffix:
Gender:F
Credentials:BAN, RN, PHN, SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8079 EVERGREEN LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3266
Mailing Address - Country:US
Mailing Address - Phone:612-964-0523
Mailing Address - Fax:
Practice Address - Street 1:8079 EVERGREEN LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-3266
Practice Address - Country:US
Practice Address - Phone:612-964-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200630-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse