Healthcare Provider Details

I. General information

NPI: 1356321962
Provider Name (Legal Business Name): BARBARA ANNE LEDNICKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 E CAMELBACK RD SUITE 170
PHOENIX AZ
85016-3911
US

IV. Provider business mailing address

1661 E CAMELBACK RD SUITE 170
PHOENIX AZ
85016-3911
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-9550
  • Fax: 602-263-1150
Mailing address:
  • Phone: 602-263-9550
  • Fax: 602-263-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22344
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: