Healthcare Provider Details

I. General information

NPI: 1902022502
Provider Name (Legal Business Name): LEISA O SANCHEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 W ASCENSION WAY STE 225
MURRAY UT
84123-2985
US

IV. Provider business mailing address

2983 W 11770 S
SOUTH JORDAN UT
84095-7944
US

V. Phone/Fax

Practice location:
  • Phone: 801-716-7008
  • Fax: 888-990-1557
Mailing address:
  • Phone: 801-302-8526
  • Fax: 801-446-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4924659-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4924659-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: