Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN137139 AP2660 | AZ |
NPI | 1033303185 |
---|---|
Provider Name | Julie A Leader |
First Address | Sedona, AZ 86351-9013 |
Second Address | Sedona, AZ 86351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2007 |
Last Update Date | 28/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305231 | (05) | AZ |