Provider Demographics
NPI:1407337504
Name:MUDGE, LESLIE MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHELLE
Last Name:MUDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5799 STETSON HILLS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4223
Mailing Address - Country:US
Mailing Address - Phone:719-471-2273
Mailing Address - Fax:719-380-0228
Practice Address - Street 1:6908 MESA RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1533
Practice Address - Country:US
Practice Address - Phone:719-505-3822
Practice Address - Fax:719-380-0228
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994106-NP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily