Basic Information
| Provider Information | |||||||||
| NPI: | 1699075549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARL | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8422 E SHEA BLVD | ||||||||
| Address2: | 103 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804786620 | ||||||||
| FaxNumber: | 4804786628 | ||||||||
| Practice Location | |||||||||
| Address1: | 8422 E SHEA BLVD | ||||||||
| Address2: | 103 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804786620 | ||||||||
| FaxNumber: | 4804786628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2010 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN 148406 | AZ | N | Nursing Service Providers | Registered Nurse | 367500000X | CRNA 0713 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | RN 418428 | CA | N | Nursing Service Providers | Registered Nurse |
No ID Information.