Provider Demographics
NPI:1467619296
Name:MORMILE, LESLIE DIANE (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:DIANE
Last Name:MORMILE
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:DIANE
Other - Last Name:HOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:2453 TRES LAGOS
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7739
Mailing Address - Country:US
Mailing Address - Phone:575-551-1183
Mailing Address - Fax:575-210-5001
Practice Address - Street 1:9397 CROWN CREST BLVD STE 440
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8789
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR172346-7163WP0809X
CANP95012547363LP0808X
COC-APN.0101333-C-NP363LP0808X
NMCNP-02767363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult