Provider Demographics
NPI:1134492689
Name:MOAK, LESLEY ERIN (FNP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ERIN
Last Name:MOAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:MOAK
Other - Last Name:KRZYSTYNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:750 WARNER DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5297
Mailing Address - Country:US
Mailing Address - Phone:303-925-4340
Mailing Address - Fax:303-925-4341
Practice Address - Street 1:750 WARNER DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5297
Practice Address - Country:US
Practice Address - Phone:303-925-4340
Practice Address - Fax:303-925-4341
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO178308163W00000X
COAPN.0990260-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse