Individual
LESLIE HAGENSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, FNP-BC
Contact information
Practice address
103 W 3RD STREET, NEW PHYSICAL ADDRESS, MARBLETON, WY 83113
(307) 276-3306
(307) 276-3024
Mailing address
PO BOX E, 9615 HWY 191, PINEDALE, WY 82941-3040
(307) 231-9562
(307) 276-3024
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
340
AK
363LF0000X
Family Nurse Practitioner
Primary
8665.0048
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124348900
—
WY
Enumeration date
12/02/2005
Last updated
03/23/2017
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