=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528905726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUADRA MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2026
-----------------------------------------------------
Last Update Date | 05/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11611 S FOOTHILLS BLVD STE A
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85367-5845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-247-9333
-----------------------------------------------------
Fax | 928-247-9335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11611 S FOOTHILLS BLVD STE A
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85367-5845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-247-9333
-----------------------------------------------------
Fax | 928-247-9335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEA JERPSETH
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 928-247-9333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------