Provider Demographics
NPI:1245340165
Name:LEGUIZAMON, PAULETTE (CFNP)
Entity type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:
Last Name:LEGUIZAMON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19560 N CANYON WHISPER DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-4403
Mailing Address - Country:US
Mailing Address - Phone:623-815-2900
Mailing Address - Fax:623-583-1319
Practice Address - Street 1:14973 W BELL RD
Practice Address - Street 2:SUITE #100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3202
Practice Address - Country:US
Practice Address - Phone:623-815-2900
Practice Address - Fax:623-583-1319
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1677AZ163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870362Medicaid
AZZ122183Medicare UPIN
AZS93588Medicare UPIN