Provider Demographics
NPI:1811198609
Name:MURTAGH, LESLIE A (APRN)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:MURTAGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3809
Mailing Address - Country:US
Mailing Address - Phone:307-472-9890
Mailing Address - Fax:307-472-9891
Practice Address - Street 1:350 W A ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1860
Practice Address - Country:US
Practice Address - Phone:307-472-9890
Practice Address - Fax:307-472-9891
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19778.237364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent