Provider Demographics
NPI:1700807286
Name:ROWENS, LESLIE DAWN (PA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DAWN
Last Name:ROWENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 S FORT APACHE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5585
Mailing Address - Country:US
Mailing Address - Phone:702-307-7941
Mailing Address - Fax:702-307-7907
Practice Address - Street 1:6070 S FORT APACHE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5585
Practice Address - Country:US
Practice Address - Phone:702-307-7941
Practice Address - Fax:702-307-7907
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA977363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102671Medicare ID - Type UnspecifiedMEDICARE
NVQ71648Medicare UPIN