Healthcare Provider Details

I. General information

NPI: 1699049569
Provider Name (Legal Business Name): LESLIE B LAFFERTY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18330 N 79TH AVE APT 1021
GLENDALE AZ
85308-8343
US

IV. Provider business mailing address

18330 N 79TH AVE APT 1021
GLENDALE AZ
85308-8343
US

V. Phone/Fax

Practice location:
  • Phone: 623-400-1049
  • Fax:
Mailing address:
  • Phone: 623-400-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN134348
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: