Wagenberg-Grella, Leslie A
Wagenberg-Grella, Leslie A is an individual health care provider with primary practice located at 120 Medical Blvd Suite 106, Spring Hill FL 34609-0220. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Wagenberg-Grella, Leslie A can be contacted via phone (352) 684-1340.Contact Information
Primary practice address
120 Medical Blvd Suite 106
Spring Hill FL 34609-0220
Phone: (352) 684-1340
Fax: (352) 684-0694
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | ME 110500 | Florida |
Profile Details
| NPI number | 1518240456 |
|---|---|
| LBN Legal business name | Wagenberg-Grella, Leslie A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 27th, 2011 |
| Last updated | Sep 14th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518240456 | NPPES |
| Florida | MEDICAID | 006606100 |
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