Provider Demographics
NPI:1386742989
Name:SHAW, LESLIE KOZIAR (RN,FNP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:KOZIAR
Last Name:SHAW
Suffix:
Gender:F
Credentials:RN,FNP-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:SUSAN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,FNP-C
Mailing Address - Street 1:15002 LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6341
Mailing Address - Country:US
Mailing Address - Phone:806-281-3431
Mailing Address - Fax:
Practice Address - Street 1:3305 101ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-4076
Practice Address - Country:US
Practice Address - Phone:806-281-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily