Basic Information
| Provider Information | |||||||||
| NPI: | 1205361078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEON | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6677 W THUNDERBIRD RD STE A124 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853063710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237732266 | ||||||||
| FaxNumber: | 6237732267 | ||||||||
| Practice Location | |||||||||
| Address1: | 6677 W THUNDERBIRD RD STE A124 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853063710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237732266 | ||||||||
| FaxNumber: | 6237732267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2017 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN180193 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | AP10207 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.