Provider Demographics
NPI:1144358524
Name:MACKOWIAK, LESLIE ANN (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:MACKOWIAK
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Gender:F
Credentials:NP
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Mailing Address - Street 1:WARNER AVE & COLLEGE DR
Mailing Address - Street 2:CHICO STATE UNIVERSITY - STUDENT HEALTH SERVICE
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95929-0777
Mailing Address - Country:US
Mailing Address - Phone:530-898-5241
Mailing Address - Fax:530-898-4057
Practice Address - Street 1:WARNER AVE AND COLLEGE DR
Practice Address - Street 2:CHICO STATE UNIVERSITY STUDENT HEALTH SERVICE
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0777
Practice Address - Country:US
Practice Address - Phone:530-898-5241
Practice Address - Fax:530-898-4057
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-03-18
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Provider Licenses
StateLicense IDTaxonomies
CARN159936363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health