Provider Demographics
NPI:1518243187
Name:LEEFLANG, CANESSA CRAIGO (FNP)
Entity Type:Individual
Prefix:
First Name:CANESSA
Middle Name:CRAIGO
Last Name:LEEFLANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CANESSA
Other - Middle Name:
Other - Last Name:CRAIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:12272 S 800 E
Mailing Address - Street 2:STE A
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9789
Mailing Address - Country:US
Mailing Address - Phone:801-523-1300
Mailing Address - Fax:801-523-1301
Practice Address - Street 1:12272 S 800 E
Practice Address - Street 2:STE A
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9789
Practice Address - Country:US
Practice Address - Phone:801-523-1300
Practice Address - Fax:801-523-1301
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59947704405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics