Provider Demographics
NPI:1285779512
Name:NEUBECKER-CZUBKO, LESLIE ANN (RD)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:NEUBECKER-CZUBKO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 PEMBERTON LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-7127
Mailing Address - Country:US
Mailing Address - Phone:517-206-2535
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1952
Practice Address - Country:US
Practice Address - Phone:517-663-9453
Practice Address - Fax:517-663-2652
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI811559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered