Provider Demographics
NPI:1700517794
Name:LEISHMAN, TERI LEE (APP AG-CNS)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LEE
Last Name:LEISHMAN
Suffix:
Gender:F
Credentials:APP AG-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 MONUMENT VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1070
Mailing Address - Country:US
Mailing Address - Phone:801-645-1175
Mailing Address - Fax:
Practice Address - Street 1:2108 MONUMENT VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-1070
Practice Address - Country:US
Practice Address - Phone:801-645-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1626684364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative