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NPI Code Detail

MEDICARE: LESLEY JORGENSEN KLOCK FNP-C

MEDICARE: LESLEY JORGENSEN KLOCK FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP8476AZ

General Provider Information

NPI Number : 1629423413
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLEY JORGENSEN KLOCK FNP-C
Provider Business Mailing Address
First Line : 374 W CITATION LN
Second Line :
City : TEMPE
State : AZ
Zip : 85284-1358
Country : US
Telephone Number : 480-707-3284
Fax Number :
Provider Business Practice Location Address
First Line : 4430 E RAY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-6092
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2016
Last Update Date : 04/28/2016

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