Healthcare Provider Details

I. General information

NPI: 1043766249
Provider Name (Legal Business Name): LEANDRA GABRIELLE OGAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 09/10/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 S VALLEY DR STE B
LAS CRUCES NM
88005-3165
US

IV. Provider business mailing address

1455 S VALLEY DR STE B
LAS CRUCES NM
88005-3165
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-6992
  • Fax:
Mailing address:
  • Phone: 575-449-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69496
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-76968
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: