Provider Demographics
NPI:1164850665
Name:LEONG, MARY PRISCILLA (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PRISCILLA
Last Name:LEONG
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Gender:F
Credentials:AGACNP-BC
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Mailing Address - Street 1:2450 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5069
Mailing Address - Country:US
Mailing Address - Phone:575-532-5455
Mailing Address - Fax:575-532-5641
Practice Address - Street 1:4301 E LOHMAN AVE STE 122
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8255
Practice Address - Country:US
Practice Address - Phone:575-556-6855
Practice Address - Fax:575-556-6859
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2021-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-02271363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM322393YKWTMedicare UPIN