Provider Demographics
NPI:1336260447
Name:BEAN, LESLIE ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:BEAN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:777 HOSPITAL WAY
Mailing Address - Street 2:101
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-234-2001
Mailing Address - Fax:208-232-2195
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:101
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-234-2001
Practice Address - Fax:208-232-2195
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT216673-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS93864Medicare UPIN