Provider Demographics
NPI:1356486864
Name:ABRAHAM, LESLIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 S DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84754-3283
Mailing Address - Country:US
Mailing Address - Phone:435-896-5451
Mailing Address - Fax:435-896-4353
Practice Address - Street 1:70 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1868
Practice Address - Country:US
Practice Address - Phone:435-896-5451
Practice Address - Fax:435-896-4353
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186844-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health