Provider Demographics
NPI:1760924534
Name:ACKER, LEEANN M (PA-C)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:M
Last Name:ACKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14541 W INDIAN SCHOOL RD
Mailing Address - Street 2:STE 600
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-535-5599
Mailing Address - Fax:623-535-4696
Practice Address - Street 1:14541 W INDIAN SCHOOL RD
Practice Address - Street 2:STE 600
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-535-5599
Practice Address - Fax:623-535-4696
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant