Provider Demographics
NPI:1659597409
Name:SCARBROUGH, LESLI A (RN)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:A
Last Name:SCARBROUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1522
Mailing Address - Country:US
Mailing Address - Phone:208-414-0641
Mailing Address - Fax:
Practice Address - Street 1:885 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4626
Practice Address - Country:US
Practice Address - Phone:541-823-0101
Practice Address - Fax:541-823-0909
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-30382163WA0400X
OR163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)