Provider Demographics
NPI:1912180746
Name:MCGLYNN, LEILANI THERESA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEILANI
Middle Name:THERESA
Last Name:MCGLYNN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:LEILANI
Other - Middle Name:THERESA
Other - Last Name:HUBENER, VANHOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1850 N CENTRAL AVE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4527
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:1850 N CENTRAL AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4527
Practice Address - Country:US
Practice Address - Phone:602-262-8900
Practice Address - Fax:602-262-8890
Is Sole Proprietor?:No
Enumeration Date:2007-12-15
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217746163W00000X
TN15068207Q00000X
AZAP7473363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527578Medicaid
TN15068OtherLICENSE
1679839492OtherMEDICARE GROUP NPI
1679839492OtherMEDICARE GROUP NPI