Provider Demographics
NPI:1366430977
Name:FIFER, LESLIE S (ARNP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:S
Last Name:FIFER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4627
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-0627
Mailing Address - Country:US
Mailing Address - Phone:509-624-1244
Mailing Address - Fax:509-624-1244
Practice Address - Street 1:2317 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5809
Practice Address - Country:US
Practice Address - Phone:509-624-1244
Practice Address - Fax:509-624-6240
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9209238363L00000X
WAAP30006266363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4751XMedicare ID - Type Unspecified
P85556Medicare UPIN
FLU4751YMedicare ID - Type Unspecified
FLU4751ZMedicare ID - Type Unspecified