Provider Demographics
NPI:1275010035
Name:SAMPSON-SEITZ, LEIGH-ANDREW THOMAS (APRN)
Entity Type:Individual
Prefix:
First Name:LEIGH-ANDREW
Middle Name:THOMAS
Last Name:SAMPSON-SEITZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 700 EAST
Mailing Address - Street 2:STE B #333
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-656-7124
Mailing Address - Fax:
Practice Address - Street 1:3269 S MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3767
Practice Address - Country:US
Practice Address - Phone:801-656-7124
Practice Address - Fax:385-243-3021
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6668154-4405363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily