Healthcare Provider Details

I. General information

NPI: 1235355009
Provider Name (Legal Business Name): JENNIFER JEAN LESPRON RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W GREENWAY RD SUITE 130
PHOENIX AZ
85023-4226
US

IV. Provider business mailing address

2525 W GREENWAY RD SUITE 130
PHOENIX AZ
85023-4226
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-8000
  • Fax: 602-942-8025
Mailing address:
  • Phone: 602-942-8000
  • Fax: 602-942-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN038991
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: