Provider Demographics
NPI:1255047528
Name:EISCHEID, LESLIE ERIN
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ERIN
Last Name:EISCHEID
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 1:22315 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-8992
Mailing Address - Country:US
Mailing Address - Phone:712-579-4154
Mailing Address - Fax:
Practice Address - Street 1:311 S CLARK ST STE 275
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3086
Practice Address - Country:US
Practice Address - Phone:712-794-6780
Practice Address - Fax:515-274-7245
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114272163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care