Provider Demographics
NPI:1700171030
Name:DE JARAY, LESLEY KARIN (NP-C)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:KARIN
Last Name:DE JARAY
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 1:172 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAND POINT
Mailing Address - State:AK
Mailing Address - Zip Code:99661-0172
Mailing Address - Country:US
Mailing Address - Phone:907-383-3151
Mailing Address - Fax:
Practice Address - Street 1:3380 C ST.
Practice Address - Street 2:STE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3949
Practice Address - Country:US
Practice Address - Phone:907-277-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK32921163W00000X
AK1231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse