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General NPI Number Information
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NPI Number | 1912180746
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Entity Type | Individual
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Provider Name | LEILANI THERESA MCGLYNN FNP
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Gender | Female
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Dates
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Enumeration Date | 12/15/2007
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 1850 N CENTRAL AVE SUITE 1600
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City | PHOENIX
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State | AZ
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Zip | 85004-4527
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Country | US
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Telephone | 602-262-8900
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Fax | 602-262-8890
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Provider Business Mailing Address
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Address Line | 1850 N CENTRAL AVE SUITE 1600
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City | PHOENIX
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State | AZ
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Zip | 85004-4527
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Country | US
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Telephone | 602-262-8900
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Fax | 602-262-8890
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 217746
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15068
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP7473
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License Number State | AZ
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