Provider Demographics
NPI:1962784504
Name:RASCH, LESLIE (NP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:RASCH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38091
Mailing Address - Street 2:384 WEST 400 SOUTH
Mailing Address - City:LEAMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84638-0091
Mailing Address - Country:US
Mailing Address - Phone:435-253-0438
Mailing Address - Fax:
Practice Address - Street 1:1380 EAST MEDICAL DRIVE
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER PALLIATIVE CARE
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-251-2474
Practice Address - Fax:435-251-2475
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT272113-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily