Provider Demographics
NPI:1033470968
Name:LEYKAM, PAIGE (APRN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LEYKAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:14780 W MOUNTAIN VIEW BLVD STE 211
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7281
Practice Address - Country:US
Practice Address - Phone:480-428-7678
Practice Address - Fax:480-569-2708
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ227235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner