Provider Demographics
NPI:1962607747
Name:GARTLEY, LESLIE ANN (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:GARTLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2447
Mailing Address - Country:US
Mailing Address - Phone:207-764-5541
Mailing Address - Fax:207-328-4231
Practice Address - Street 1:2318 S 113TH AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-9179
Practice Address - Country:US
Practice Address - Phone:623-208-3920
Practice Address - Fax:207-328-4231
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO33526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily