Provider Demographics
NPI:1306097258
Name:LEONARD, MELISSA ANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:#275
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2754
Mailing Address - Country:US
Mailing Address - Phone:602-254-3151
Mailing Address - Fax:602-256-9581
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:#275
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-254-3151
Practice Address - Fax:602-256-9581
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2012-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ437701Medicaid