Basic Information
Provider Information
NPI: 1306945118
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEZATE
FirstName: LESLIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: R.N., C.P.N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ARNETT
OtherFirstName: LESLIE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: R.N.
OtherLastNameType: 1
Mailing Information
Address1: 6301 S MCCLINTOCK DR
Address2: #101
City: TEMPE
State: AZ
PostalCode: 852833392
CountryCode: US
TelephoneNumber: 4802142300
FaxNumber: 4802142301
Practice Location
Address1: 6301 S MCCLINTOCK DR
Address2: #101
City: TEMPE
State: AZ
PostalCode: 852833392
CountryCode: US
TelephoneNumber: 4802142300
FaxNumber: 4802142301
Other Information
ProviderEnumerationDate: 09/21/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XRN011738AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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