Provider Demographics
NPI:1932763323
Name:BASS, JOAN LESLIE (NP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:LESLIE
Last Name:BASS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 CEDARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2144
Mailing Address - Country:US
Mailing Address - Phone:484-357-7507
Mailing Address - Fax:
Practice Address - Street 1:6255 STERNERS WAY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9464
Practice Address - Country:US
Practice Address - Phone:610-807-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily