Provider Demographics
NPI:1538479225
Name:MAGNUSSEN, LESLEY ELIZABETH (NP-C)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:ELIZABETH
Last Name:MAGNUSSEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3525 W OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3106
Mailing Address - Country:US
Mailing Address - Phone:303-315-6150
Mailing Address - Fax:
Practice Address - Street 1:7155 E 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1630
Practice Address - Country:US
Practice Address - Phone:800-230-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20194363LA2200X
DCRN1034893363LA2200X
COC-APN.0002781363LW0102X
COAPN.0998283-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000195822Medicaid