Healthcare Provider Details

I. General information

NPI: 1740255181
Provider Name (Legal Business Name): LESLIE A JOHNSON F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 401
PHOENIX AZ
85027-4013
US

IV. Provider business mailing address

P.O. BOX 29870
PHOENIX AZ
85038-9870
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-8888
  • Fax: 602-978-4129
Mailing address:
  • Phone: 602-772-3800
  • Fax: 602-772-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN091028
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 1352
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: