Provider Demographics
NPI:1871745141
Name:EARSLEY, LESLIE A
Entity type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:A
Last Name:EARSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 VINE ST APT G38
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5322
Mailing Address - Country:US
Mailing Address - Phone:315-383-9093
Mailing Address - Fax:
Practice Address - Street 1:1150 VINE ST APT G38
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5322
Practice Address - Country:US
Practice Address - Phone:315-383-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292939164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse