Provider Demographics
NPI:1811343544
Name:WASHATKO, LESLEY
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:
Last Name:WASHATKO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:STEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2710
Mailing Address - Country:US
Mailing Address - Phone:715-623-2351
Mailing Address - Fax:
Practice Address - Street 1:110 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2710
Practice Address - Country:US
Practice Address - Phone:715-623-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant