Provider Demographics
NPI:1598127755
Name:VANDOVER, LESLIE JOAN (RN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JOAN
Last Name:VANDOVER
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E FOOTHILL BLVD
Mailing Address - Street 2:APU SCHOOL OF NURSING
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2606
Mailing Address - Country:US
Mailing Address - Phone:626-815-5378
Mailing Address - Fax:626-815-5414
Practice Address - Street 1:16127 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:626-378-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95002272363L00000X
CA553516163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner