Individual
LESLIE RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1231 CAMELOT DR, PROVO, UT 84601-1454
(801) 691-9875
Mailing address
1840 S 1300 E, SALT LAKE CITY, UT 84105-3617
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
277694-4405
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2021
Last updated
12/29/2023
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