Healthcare Provider Details

I. General information

NPI: 1699958132
Provider Name (Legal Business Name): LEANDRA RAE ESPESETH M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 COPPER AVE NE
ALBUQUERQUE NM
87108-1473
US

IV. Provider business mailing address

5200 COPPER AVE NE
ALBUQUERQUE NM
87108-1473
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-5557
  • Fax: 505-266-5545
Mailing address:
  • Phone: 505-266-5557
  • Fax: 505-266-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR36450
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number417314
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: