Provider Demographics
NPI:1902022502
Name:SANCHEZ, LEISA O (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LEISA
Middle Name:O
Last Name:SANCHEZ
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 1:2983 W 11770 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7944
Mailing Address - Country:US
Mailing Address - Phone:801-302-8526
Mailing Address - Fax:801-446-6883
Practice Address - Street 1:434 W ASCENSION WAY STE 225
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2985
Practice Address - Country:US
Practice Address - Phone:801-716-7008
Practice Address - Fax:888-990-1557
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4924659-3102163WH0200X
UT4924659-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1902022502Medicaid