Provider Demographics
NPI:1063874550
Name:ANGMOR, LESHAUN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LESHAUN
Middle Name:
Last Name:ANGMOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MOUNTAIN VIEW TER
Mailing Address - Street 2:APT 7
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2049
Mailing Address - Country:US
Mailing Address - Phone:518-491-6601
Mailing Address - Fax:
Practice Address - Street 1:315 2ND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-3237
Practice Address - Country:US
Practice Address - Phone:518-235-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340500-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily