LESLIE A WAGENBERG-GRELLA (Credential# 549951) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 23, 2004. The license expiration date date is September 30, 2005. The license status is INACTIVE.
LESLIE A WAGENBERG-GRELLA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.032339. The credential type is physician/surgeon. The effective date is September 23, 2004. The expiration date is September 30, 2005. The business address is 210 Siler Rd., Taos, NM 87571-6111. The current status is inactive.
| Licensee Name | LESLIE A WAGENBERG-GRELLA |
| Credential ID | 549951 |
| Credential Number | 1.032339 |
| Credential Type | Physician/Surgeon |
| Business Address |
210 Siler Rd. Taos NM 87571-6111 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1992-06-05 |
| Effective Date | 2004-09-23 |
| Expiration Date | 2005-09-30 |
| Refresh Date | 2009-07-08 |
| Street Address | 210 Siler Rd. |
| City | TAOS |
| State | NM |
| Zip Code | 87571-6111 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Edward A Rodriguez | 1013 Witt Road, Taos, NM 87571 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Susan L Roberts · Mitchell | 8064 Ndcbu, Taos, NM 87571 | Registered Nurse | 2001-12-04 ~ 2002-12-31 |
| David K Sargert | 122 C Paseo Del Pueblo Sur, Taos, NM 87571 | Interior Designer | 2006-01-01 ~ 2006-12-31 |
| Leslie A Wagenberg Md | 5257 Ndcbu, Taos, NM 87571 | Controlled Substance Registration for Practitioner | 2007-05-08 ~ 2008-02-29 |
| Nancy E Coppola | General Delivery, Taos, NM 87571 | Registered Nurse | 1998-01-30 ~ 1998-10-31 |
| Suzanne E Kiermont | Po Box 3671, Taos, NM 87571-3671 | Dental Hygienist | 2020-03-01 ~ 2021-02-28 |
| Lilly-marie M Blecher | 1331 Maestas Rd, Taos, NM 87571-6268 | Naturopathic Physician | 2019-12-01 ~ 2020-11-30 |
| City | TAOS |
| Zip Code | 87571 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + TAOS |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Leslie A Wagenberg Md | 5257 Ndcbu, Taos, NM 87571 | Controlled Substance Registration for Practitioner | 2007-05-08 ~ 2008-02-29 |
| Grella's Market | 92 Congress Ave, Waterbury, CT 06701 | Non Legend Drug Permit | ~ 1995-12-31 |
| L A Grella Painting LLC | 56 Timothy Rd, Naugatuck, CT 06770 | Home Improvement Contractor | 2017-12-01 ~ 2018-11-30 |
| Leslie Coopersmith | 133 Scovill St. Ste. 101, Waterbury, CA 06706 | Physician/surgeon | ~ |
| Leslie Jacobsen Md | 45 Reservoir St, New Haven, CT 06511 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Leslie M. Rickey | 25 Alston Ave, New Haven, CT 06515-2702 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Leslie Hsiung | 701 5th Ave Ste 2300, Seattle, WA 98104 | Physician/surgeon | 2019-12-01 ~ 2020-11-30 |
| Leslie A. Oleksowicz | 11 Maywood Dr, Old Lyme, CT 06371-1544 | Physician/surgeon | 2014-04-01 ~ 2015-03-31 |
| Leslie Donovan Md | 159 W Putnam Ave, Greenwich, CT 06830-5329 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Leslie Buckley | 129 York St#8k, New Haven, CT 06511 | Physician/surgeon | 2004-06-25 ~ 2005-05-31 |
Please comment or provide details below to improve the information on LESLIE A WAGENBERG-GRELLA.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).