| NPI | 1710115506 |
|---|---|
| Former Name | LESLIE PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 856240) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R856240) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2024-06-28 |