Provider Demographics
NPI:1235133877
Name:LEIGH, CHERYL L (FNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:LEIGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3638
Mailing Address - Country:US
Mailing Address - Phone:602-372-2039
Mailing Address - Fax:602-372-2862
Practice Address - Street 1:1645 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3638
Practice Address - Country:US
Practice Address - Phone:602-372-2039
Practice Address - Fax:602-372-2862
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN037728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ432873OtherAHCCCS NUMBER
AZP30353Medicare UPIN