Provider Demographics
NPI:1396889903
Name:MADDUX, LESLIE FAYE (LVN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:FAYE
Last Name:MADDUX
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 COUNTY ROAD 1653
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:TX
Mailing Address - Zip Code:76431-3611
Mailing Address - Country:US
Mailing Address - Phone:940-210-1947
Mailing Address - Fax:
Practice Address - Street 1:1032 COUNTY ROAD 1653
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:TX
Practice Address - Zip Code:76431-3611
Practice Address - Country:US
Practice Address - Phone:940-210-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148550164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse