Provider Demographics
NPI:1134746951
Name:GRAU, LEAH BETH (APRN, CNP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:BETH
Last Name:GRAU
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E RIVULON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0087
Mailing Address - Country:US
Mailing Address - Phone:602-739-8836
Mailing Address - Fax:480-534-4087
Practice Address - Street 1:161 E RIVULON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0087
Practice Address - Country:US
Practice Address - Phone:602-739-8836
Practice Address - Fax:480-534-4087
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ243311363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology