Provider Demographics
NPI:1699074096
Name:LESIAK, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:LESIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 N 96TH ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2508
Mailing Address - Country:US
Mailing Address - Phone:402-330-4555
Mailing Address - Fax:402-330-4626
Practice Address - Street 1:909 N 96TH ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2508
Practice Address - Country:US
Practice Address - Phone:402-330-4555
Practice Address - Fax:402-330-4626
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program