Provider Demographics
NPI:1154517662
Name:SMALL, LEIGH (PHD, RN, CPNP-PC)
Entity type:Individual
Prefix:PROF
First Name:LEIGH
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:PHD, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N 3RD ST
Mailing Address - Street 2:MAIL CODE 3020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2135
Mailing Address - Country:US
Mailing Address - Phone:602-496-0910
Mailing Address - Fax:
Practice Address - Street 1:500 N 3RD ST
Practice Address - Street 2:MAIL CODE 3020
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2135
Practice Address - Country:US
Practice Address - Phone:602-496-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2044363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP2044OtherADVANCED PRACTICE NP