Provider Demographics
NPI:1376975797
Name:POWELL, LESLIE ANNE (CNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANNE
Last Name:POWELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 RANCHO DEL ORO RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-1729
Mailing Address - Country:US
Mailing Address - Phone:760-643-4472
Mailing Address - Fax:
Practice Address - Street 1:1300 RANCHO DEL ORO RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-1729
Practice Address - Country:US
Practice Address - Phone:760-643-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14973363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner