Healthcare Provider Details

I. General information

NPI: 1699886366
Provider Name (Legal Business Name): LESLIE E DO PICO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BEARD CREEK ROAD SUITE 100
EDWARDS CO
81632-6426
US

IV. Provider business mailing address

PO BOX 913001
DENVER CO
80291-3001
US

V. Phone/Fax

Practice location:
  • Phone: 970-569-7400
  • Fax: 817-877-0350
Mailing address:
  • Phone: 817-334-0530
  • Fax: 817-877-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9170464
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0993819-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: