Provider Demographics
NPI:1124460647
Name:YODER, LESLIE ALLISON (RN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ALLISON
Last Name:YODER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:WA
Mailing Address - Zip Code:98591-0656
Mailing Address - Country:US
Mailing Address - Phone:360-751-9069
Mailing Address - Fax:360-864-8469
Practice Address - Street 1:220 S SECOND ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:WA
Practice Address - Zip Code:98591-0656
Practice Address - Country:US
Practice Address - Phone:360-751-9069
Practice Address - Fax:360-864-8469
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60004840163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse