Healthcare Provider Details

I. General information

NPI: 1902101801
Provider Name (Legal Business Name): LESLIE DIANNE CANICATTI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 08/20/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 W MORENO AVE
COLORADO SPRINGS CO
80905-1731
US

IV. Provider business mailing address

6530 S YOSEMITE ST STE 210
GREENWOOD VILLAGE CO
80111-5128
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6200
  • Fax: 719-572-6299
Mailing address:
  • Phone: 720-778-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197514
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996678-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: