Healthcare Provider Details

I. General information

NPI: 1063595247
Provider Name (Legal Business Name): LESLIE JANE SCHILLER RN MS CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MAIN ST
GRAND JUNCTION CO
81501-3538
US

IV. Provider business mailing address

951 MAIN ST
GRAND JUNCTION CO
81501-3538
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-4567
  • Fax: 970-248-9006
Mailing address:
  • Phone: 970-242-4567
  • Fax: 970-248-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number121200
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: