Provider Demographics
NPI:1275913824
Name:HASS, LESLIE A (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:HASS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 N 2200 E
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328-5260
Mailing Address - Country:US
Mailing Address - Phone:208-751-9708
Mailing Address - Fax:208-736-0890
Practice Address - Street 1:475 POLK ST STE F
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4864
Practice Address - Country:US
Practice Address - Phone:208-751-9708
Practice Address - Fax:208-736-0890
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1571A363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology