Provider Demographics
NPI:1467665232
Name:KAMPFE-LEACHER, RENEE JEAN (NP)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:JEAN
Last Name:KAMPFE-LEACHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:JEAN
Other - Last Name:LEACHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1445 W CHANDLER BLVD
Mailing Address - Street 2:BLDG. B10
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5294
Mailing Address - Country:US
Mailing Address - Phone:480-385-5055
Mailing Address - Fax:480-385-5054
Practice Address - Street 1:1445 W CHANDLER BLVD
Practice Address - Street 2:BLDG. B10
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5294
Practice Address - Country:US
Practice Address - Phone:480-385-5055
Practice Address - Fax:480-385-5054
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2826363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ505479Medicaid