Healthcare Provider Details

I. General information

NPI: 1265689970
Provider Name (Legal Business Name): DEBRA MALECKI LEDINGTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BEAVER ST PAYER CREDENTIALING
FLAGSTAFF AZ
86001-3118
US

IV. Provider business mailing address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

V. Phone/Fax

Practice location:
  • Phone: 928-779-3366
  • Fax:
Mailing address:
  • Phone: 928-779-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP6387
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN080717
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: