Healthcare Provider Details

I. General information

NPI: 1518243187
Provider Name (Legal Business Name): CANESSA CRAIGO LEEFLANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANESSA CRAIGO FNP

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 W 2230 N STE 203
PROVO UT
84604-1533
US

IV. Provider business mailing address

364 W 2230 N STE 203
PROVO UT
84604-1533
US

V. Phone/Fax

Practice location:
  • Phone: 385-268-5322
  • Fax: 385-268-5323
Mailing address:
  • Phone: 385-268-5322
  • Fax: 385-268-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number59947704405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: