Provider Demographics
NPI:1891921250
Name:CANFIELD, LESLIE KRISTINE (CRNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:KRISTINE
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-1976
Mailing Address - Country:US
Mailing Address - Phone:334-774-5100
Mailing Address - Fax:334-774-5110
Practice Address - Street 1:145 KATHERINE AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-1976
Practice Address - Country:US
Practice Address - Phone:334-774-5100
Practice Address - Fax:334-774-5110
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-066627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily