Provider Demographics
NPI:1922386010
Name:DERKSEN, LEAH (NP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DERKSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 N CIRCLE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-634-8891
Mailing Address - Fax:719-634-1897
Practice Address - Street 1:2960 N CIRCLE DR
Practice Address - Street 2:STE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-634-8891
Practice Address - Fax:719-634-1897
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78270766Medicaid