Provider Demographics
NPI:1659656072
Name:OSTROM, LESLIE A (ARNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:OSTROM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:509-951-1255
Mailing Address - Fax:509-533-0627
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:SUITE 415
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-951-1255
Practice Address - Fax:509-533-0627
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60252666363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health