Healthcare Provider Details

I. General information

NPI: 1811233059
Provider Name (Legal Business Name): LESLIE CHURAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 HARPER DR NE
ALBUQUERQUE NM
87109-3587
US

IV. Provider business mailing address

3508 YOSEMITE DR NE
ALBUQUERQUE NM
87111-5443
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8263
  • Fax:
Mailing address:
  • Phone: 505-379-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN35922
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: