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General NPI Number Information
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NPI Number | 1962607747
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Entity Type | Individual
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Provider Name | LESLIE ANN GARTLEY FNP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 2318 S 113TH AVE
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City | AVONDALE
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State | AZ
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Zip | 85323-9179
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Country | US
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Telephone | 623-208-3920
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Fax | 207-328-4231
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Provider Business Mailing Address
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Address Line | 51 LOMBARD ST
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-2447
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Country | US
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Telephone | 207-764-5541
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Fax | 207-328-4231
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RO33526
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License Number State | ME
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