Provider Demographics
NPI:1033303185
Name:LEADER, JULIE A (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:LEADER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 VERDE VALLEY SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-9013
Mailing Address - Country:US
Mailing Address - Phone:928-634-1614
Mailing Address - Fax:928-634-1462
Practice Address - Street 1:275 VERDE VALLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351
Practice Address - Country:US
Practice Address - Phone:928-634-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN137139 AP2660363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ305231Medicaid