Provider Demographics
NPI:1477589711
Name:LEADBEATER, GREER (NP)
Entity Type:Individual
Prefix:MRS
First Name:GREER
Middle Name:
Last Name:LEADBEATER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GREER
Other - Middle Name:
Other - Last Name:GAWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4430 E RAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6092
Mailing Address - Country:US
Mailing Address - Phone:480-466-6596
Mailing Address - Fax:
Practice Address - Street 1:4430 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6092
Practice Address - Country:US
Practice Address - Phone:480-466-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN062402163W00000X
AZAP2500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZML1469293OtherDEA
AZQ70870Medicare UPIN
AZML1469293OtherDEA