Basic Information
| Provider Information | |||||||||
| NPI: | 1720519895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIELSON | ||||||||
| FirstName: | LESLEY | ||||||||
| MiddleName: | SONNET | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5546 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802175546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 W 2700 N | ||||||||
| Address2: | |||||||||
| City: | PLEASANT VIEW | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844044791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753010 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2017 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5354984-4405 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 5354987-3102 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1720519895 | 05 | UT | MEDICAID |