Provider Demographics
NPI:1699049569
Name:LAFFERTY, LESLIE B (RN)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:B
Last Name:LAFFERTY
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 1:18330 N 79TH AVE
Mailing Address - Street 2:APT 1021
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8343
Mailing Address - Country:US
Mailing Address - Phone:623-400-1049
Mailing Address - Fax:
Practice Address - Street 1:18330 N 79TH AVE
Practice Address - Street 2:APT 1021
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8343
Practice Address - Country:US
Practice Address - Phone:623-400-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN134348163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics