1730440272 NPI number — MRS. MICHELLE RAE-MARY LESHER RN, RD, LN

Table of content: (NPI 1063546133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730440272 NPI number — MRS. MICHELLE RAE-MARY LESHER RN, RD, LN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESHER
Provider First Name:
MICHELLE
Provider Middle Name:
RAE-MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, RD, LN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730440272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13815 BATTLE CREEK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMOSA
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57744-0019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-255-4101
Provider Business Mailing Address Fax Number:
605-255-4687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13815 BATTLE CREEK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMOSA
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57744-0019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-255-4101
Provider Business Practice Location Address Fax Number:
605-255-4687
Provider Enumeration Date:
05/31/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  0374 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 1003750 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)