Provider Demographics
NPI:1477052348
Name:LESKY, SHANNON ROSE (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:LESKY
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 1:7661 JACKPOT AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-3813
Mailing Address - Country:US
Mailing Address - Phone:608-475-0629
Mailing Address - Fax:
Practice Address - Street 1:1450 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-2113
Practice Address - Country:US
Practice Address - Phone:608-475-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI222198163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty