Provider Demographics
NPI:1134407489
Name:ROGERS, LESLIE CORRINE (NP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:CORRINE
Last Name:ROGERS
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 1:1327 W SUPERIOR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2742
Mailing Address - Country:US
Mailing Address - Phone:208-245-9566
Mailing Address - Fax:208-245-7653
Practice Address - Street 1:428 6TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2355
Practice Address - Country:US
Practice Address - Phone:208-263-9757
Practice Address - Fax:208-965-8128
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1090A363L00000X, 363LF0000X
WAAP61006462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2013847Medicaid