Provider Demographics
NPI:1326454810
Name:LESAAR, MELISSA JACLYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JACLYN
Last Name:LESAAR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JACLYN
Other - Last Name:KUNTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:8675 S PRIEST DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1914
Mailing Address - Country:US
Mailing Address - Phone:480-739-0007
Mailing Address - Fax:
Practice Address - Street 1:8675 S PRIEST DR STE 102
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1914
Practice Address - Country:US
Practice Address - Phone:480-739-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ154308Medicaid
AZ235326Medicaid
AZAP5684OtherAZ AP