Provider Demographics
NPI:1962538405
Name:CONNER, LESLIE E (ARNP, RN, LMP, IFMCP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:E
Last Name:CONNER
Suffix:
Gender:F
Credentials:ARNP, RN, LMP, IFMCP
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:E
Other - Last Name:MANICCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, RN, LMP, IFMCP
Mailing Address - Street 1:292 LOG CABIN LN
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-7056
Mailing Address - Country:US
Mailing Address - Phone:425-905-3050
Mailing Address - Fax:
Practice Address - Street 1:2261 MARKET ST # 10535
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1612
Practice Address - Country:US
Practice Address - Phone:408-508-4163
Practice Address - Fax:888-789-1402
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY907442363LF0000X
COC-APN.0101076-C-NP363LF0000X
WAMA006418174400000X
CA95016328363LF0000X
TX1137272363LF0000X
OR10018536363LF0000X
WAAP60191467363LF0000X
TN31974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8916264Medicare UPIN