Provider Demographics
NPI:1780855601
Name:WEST, LESLIE (FNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:WEST
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:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:BLUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97413-0183
Mailing Address - Country:US
Mailing Address - Phone:541-822-3341
Mailing Address - Fax:541-822-3836
Practice Address - Street 1:51730 DEXTER ST.
Practice Address - Street 2:
Practice Address - City:BLUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97413-0183
Practice Address - Country:US
Practice Address - Phone:541-822-3341
Practice Address - Fax:541-822-3836
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care