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General NPI Number Information
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NPI Number | 1023828159
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Entity Type | Individual
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Provider Name | LESLIE JEANETTE COOPER SULLIVAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 426 N 44TH ST STE 405
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City | PHOENIX
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State | AZ
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Zip | 85008-6612
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Country | US
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Telephone | 602-476-2047
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Fax |
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Provider Business Mailing Address
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Address Line | 10646 E CAROL AVE
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City | MESA
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State | AZ
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Zip | 85208-7434
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Country | US
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Telephone | 480-450-5999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RNP318160
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License Number State | AZ
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