Provider Demographics
NPI:1518722149
Name:AIDE, LESLIE CAMILLE (FNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CAMILLE
Last Name:AIDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 UNIVERSITY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5618
Mailing Address - Country:US
Mailing Address - Phone:701-609-2004
Mailing Address - Fax:406-206-7337
Practice Address - Street 1:221 UNIVERSITY AVE STE 102
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5618
Practice Address - Country:US
Practice Address - Phone:701-609-2004
Practice Address - Fax:406-206-7337
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR39981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily