Provider Demographics
NPI:1669821112
Name:PETERSON, LEEANNA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP-C
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 27973
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0149
Mailing Address - Country:US
Mailing Address - Phone:480-513-1042
Mailing Address - Fax:480-513-1043
Practice Address - Street 1:7344 E DEER VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7456
Practice Address - Country:US
Practice Address - Phone:480-513-1042
Practice Address - Fax:480-513-1043
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily