Provider Demographics
NPI:1336159045
Name:LESLIE, HAZEL SUEDE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:SUEDE
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 1:455 SHERMAN ST
Mailing Address - Street 2:STE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4400
Mailing Address - Country:US
Mailing Address - Phone:303-377-6825
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:455 SHERMAN ST
Practice Address - Street 2:STE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4400
Practice Address - Country:US
Practice Address - Phone:303-377-6825
Practice Address - Fax:303-780-0787
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679672367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192044903Medicaid
TX192044904Medicaid
CO28201779Medicaid
CO12537198OtherCAQH ID
TXP00975173OtherRAILROAD MEDICARE
TX8L16063Medicare PIN
TX192044904Medicaid
CO294758YKTG-GCAMedicare PIN
TX8L14463Medicare PIN
TX192044903Medicaid
CO28201779Medicaid