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General NPI Number Information
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NPI Number | 1356924179
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Entity Type | Individual
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Provider Name | CHRISTINE MACHELE LEACH FNP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 18433 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85023-1359
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Country | US
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Telephone | 888-698-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 18275 N 59TH AVE # K162
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City | GLENDALE
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State | AZ
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Zip | 85308-1260
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Country | US
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Telephone | 602-755-0800
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 256066
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License Number State | AZ
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