Provider Demographics
NPI:1871908020
Name:JOHNSON, LESLI
Entity type:Individual
Prefix:
First Name:LESLI
Middle Name:
Last Name:JOHNSON
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 1:150 CYPRESS GROVE CT
Mailing Address - Street 2:APT 99
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8950
Mailing Address - Country:US
Mailing Address - Phone:713-208-8006
Mailing Address - Fax:
Practice Address - Street 1:150 CYPRESS GROVE CT
Practice Address - Street 2:APT 99
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-8950
Practice Address - Country:US
Practice Address - Phone:713-208-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)