Provider Demographics
NPI:1720677958
Name:ROWLAND, LESLIE ANN (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:RAISBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1653 E LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-6702
Mailing Address - Country:US
Mailing Address - Phone:760-608-1950
Mailing Address - Fax:
Practice Address - Street 1:1081 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3130
Practice Address - Country:US
Practice Address - Phone:760-446-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016346363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care