Provider Demographics
NPI:1336261759
Name:LEON, LOIS L (RN)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:L
Last Name:LEON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-2324
Mailing Address - Country:US
Mailing Address - Phone:602-243-7645
Mailing Address - Fax:
Practice Address - Street 1:4610 S 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-2314
Practice Address - Country:US
Practice Address - Phone:602-232-4923
Practice Address - Fax:602-243-4961
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN051793163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ761884OtherAHCCCS