Provider Demographics
NPI:1528758026
Name:LEDESMA, LUELLA JO (APRN)
Entity type:Individual
Prefix:MRS
First Name:LUELLA JO
Middle Name:
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LUELLA JO
Other - Middle Name:
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6240 FIELDSTONE PL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1202
Mailing Address - Country:US
Mailing Address - Phone:775-544-2751
Mailing Address - Fax:
Practice Address - Street 1:4773 CAUGHLIN PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-1011
Practice Address - Country:US
Practice Address - Phone:775-683-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV867241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine