Provider Demographics
NPI:1902825763
Name:DAWDY, LESLIE MARIE (APN)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:MARIE
Last Name:DAWDY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ACADEMY BOULEVARD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3318
Mailing Address - Country:US
Mailing Address - Phone:719-465-2388
Mailing Address - Fax:888-975-4491
Practice Address - Street 1:1304 N ACADEMY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3318
Practice Address - Country:US
Practice Address - Phone:719-465-2388
Practice Address - Fax:888-975-4491
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990489-NP363LF0000X, 363LF0000X
IL209-004089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73289574Medicaid
CO73289574Medicaid
COCOA107997Medicare PIN