MEDICARE: LEIGH LUSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP11219	AZ
2	163W00000X	Registered Nurse	RN159792	AZ

General Provider Information

NPI Number	:	1740707744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH LUSTER

Provider Business Mailing Address
First Line	:	6945 E MAIN ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-8206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15333 N PIMA RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2783
Country	:	US
Telephone Number	:	866-949-0108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	09/11/2025

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Directions to “ LEIGH LUSTER ” Practice Location

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