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General NPI Number Information
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NPI Number | 1033553854
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Entity Type | Individual
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Provider Name | LEILA MICKLOS MS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 8415 N. PIMA RD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4509
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Country | US
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Telephone | 480-661-4761
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Fax | 480-661-3990
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Provider Business Mailing Address
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Address Line | 8415 N PIMA RD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4480
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Country | US
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Telephone | 480-661-4761
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Fax | 480-661-3990
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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 | AP4724
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License Number State | AZ
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