Provider Demographics
NPI:1871743898
Name:TENBRINK, LESLIE SUE (FNP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SUE
Last Name:TENBRINK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:SUE
Other - Last Name:TENBRINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3100 N. WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424
Mailing Address - Country:US
Mailing Address - Phone:616-994-2770
Mailing Address - Fax:616-920-6533
Practice Address - Street 1:3100 N. WELLNESS DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-994-2770
Practice Address - Fax:616-920-6533
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16094147Medicare PIN