Healthcare Provider Details

I. General information

NPI: 1871759696
Provider Name (Legal Business Name): LESLIE B. VANNUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 S QUEBEC ST # N350
GREENWOOD VILLAGE CO
80111-1909
US

IV. Provider business mailing address

5340 S QUEBEC ST # N350
GREENWOOD VILLAGE CO
80111-1909
US

V. Phone/Fax

Practice location:
  • Phone: 702-622-7766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0990395-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0990395-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN49107
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: