1154695526 NPI number — MS. LESLIE R HENDERSON BBA, MBA

Table of content: MS. LESLIE R HENDERSON BBA, MBA (NPI 1154695526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154695526 NPI number — MS. LESLIE R HENDERSON BBA, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDERSON
Provider First Name:
LESLIE
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BBA, MBA
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:
1154695526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2439 MANHATTAN BOULEVARD, HARVEY, LA 70058
Provider Second Line Business Mailing Address:
SUITE 211 ROOM 6 & ROOM 7
Provider Business Mailing Address City Name:
HARVEY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70058-5328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-225-1202
Provider Business Mailing Address Fax Number:
855-495-2118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2516 WOODMERE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70058-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-621-3211
Provider Business Practice Location Address Fax Number:
855-495-2118
Provider Enumeration Date:
03/02/2012

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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