Provider Demographics
NPI:1205204740
Name:MESSERSMITH, LESLIE (RN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MESSERSMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15323 W DREYFUS ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8131
Mailing Address - Country:US
Mailing Address - Phone:623-412-4753
Mailing Address - Fax:623-412-4755
Practice Address - Street 1:12901 N 63RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1701
Practice Address - Country:US
Practice Address - Phone:623-412-4750
Practice Address - Fax:623-412-4755
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN159636163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN159635OtherARIZONA RN LICENSE