Healthcare Provider Details

I. General information

NPI: 1477019834
Provider Name (Legal Business Name): LESLYN JOSEPH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAGLE CREST DR
RANGELY CO
81648-3105
US

IV. Provider business mailing address

999 W MAIN ST
RANGELY CO
81648-2753
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-5011
  • Fax:
Mailing address:
  • Phone: 571-505-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2238-CNP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: