Provider Demographics
NPI:1962811208
Name:PRESTENBACH, LESLIE (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:PRESTENBACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4605
Mailing Address - Country:US
Mailing Address - Phone:504-575-3712
Mailing Address - Fax:504-575-3691
Practice Address - Street 1:843 MILLING AVE
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4442
Practice Address - Country:US
Practice Address - Phone:985-307-1600
Practice Address - Fax:504-575-3691
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO7977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2377116Medicaid
MS03684747Medicaid
LA378229YH3UMedicare PIN