Provider Demographics
NPI:1902870405
Name:BURGIE, LESLIE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:BURGIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:VAN OSTRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6023 LORIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3695
Mailing Address - Country:US
Mailing Address - Phone:614-398-6879
Mailing Address - Fax:
Practice Address - Street 1:8535 REFUGEE RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9625
Practice Address - Country:US
Practice Address - Phone:740-205-2007
Practice Address - Fax:520-413-0073
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.07986363L00000X
OHNP-07986363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3038135Medicaid
OHQ68482Medicare UPIN