Provider Demographics
NPI:1548210990
Name:DEISERING, LEON FRANCIS (CRNA)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:FRANCIS
Last Name:DEISERING
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85628-0819
Mailing Address - Country:US
Mailing Address - Phone:520-287-4020
Mailing Address - Fax:520-287-2348
Practice Address - Street 1:1209 W TARGET RANGE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621
Practice Address - Country:US
Practice Address - Phone:520-287-4020
Practice Address - Fax:520-287-2348
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN129422367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ912825Medicaid
AZ912825Medicaid
R28390Medicare UPIN