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General NPI Number Information
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NPI Number | 1134407489
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Entity Type | Individual
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Provider Name | LESLIE CORRINE ROGERS NP
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 428 6TH AVE
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City | LEWISTON
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State | ID
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Zip | 83501-2355
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Country | US
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Telephone | 208-263-9757
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Fax | 208-965-8128
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Provider Business Mailing Address
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Address Line | 1327 W SUPERIOR ST STE 101
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City | SANDPOINT
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State | ID
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Zip | 83864-2742
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Country | US
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Telephone | 208-245-9566
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Fax | 208-245-7653
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP-1090A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-1090A
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61006462
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License Number State | WA
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