Healthcare Provider Details

I. General information

NPI: 1235211202
Provider Name (Legal Business Name): LESLIE PETERSON ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 S 900 E STE 140
MURRAY UT
84117-6630
US

IV. Provider business mailing address

5107 S 900 E STE 140
MURRAY UT
84117-6630
US

V. Phone/Fax

Practice location:
  • Phone: 801-746-3555
  • Fax: 801-746-3556
Mailing address:
  • Phone: 801-746-3555
  • Fax: 801-746-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number350301-7100
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: