Provider Demographics
NPI:1174554448
Name:COOK, LESLEY MARIE
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0998
Mailing Address - Country:US
Mailing Address - Phone:605-782-8305
Mailing Address - Fax:
Practice Address - Street 1:2100 S MARION RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3646
Practice Address - Country:US
Practice Address - Phone:605-322-1010
Practice Address - Fax:605-322-1011
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000408363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology