Healthcare Provider Details

I. General information

NPI: 1851765531
Provider Name (Legal Business Name): REBECCA LE ROY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13825 N 7TH ST
PHOENIX AZ
85022-4342
US

IV. Provider business mailing address

PO BOX 29675 DEPT 2025
PHOENIX AZ
85038
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-2277
  • Fax:
Mailing address:
  • Phone: 480-392-8046
  • Fax: 480-987-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN086672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: