Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP10361 | AZ |
NPI | 1003338518 |
---|---|
Provider Name | Brett Lee Leifson |
First Address | San Tan Valley, AZ 85143-7978 |
Second Address | Florence, AZ 85132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2017 |
Last Update Date | 17/07/2017 |