Provider Demographics
NPI:1669547188
Name:LESLIE, LORI A (CRNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:LESLIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844058
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4058
Mailing Address - Country:US
Mailing Address - Phone:303-438-3999
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:2800 10TH AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0703
Practice Address - Country:US
Practice Address - Phone:303-438-3999
Practice Address - Fax:303-780-0787
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN32938367500000X
NVCRNA000163367500000X
MTNUR-APRN-LIC-194511367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1669547188Medicaid