1912180746 NPI number — MRS. LEILANI THERESA MCGLYNN FNP

Table of content: MRS. LEILANI THERESA MCGLYNN FNP (NPI 1912180746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912180746 NPI number — MRS. LEILANI THERESA MCGLYNN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGLYNN
Provider First Name:
LEILANI
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUBENER, VANHOY
Provider Other First Name:
LEILANI
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912180746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 N CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85004-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-262-8900
Provider Business Mailing Address Fax Number:
602-262-8890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 1600
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85004-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-262-8900
Provider Business Practice Location Address Fax Number:
602-262-8890
Provider Enumeration Date:
12/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  217746 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 15068 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP7473 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1527578 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15068 . This is a "LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1679839492 . This is a "MEDICARE GROUP NPI" identifier . This identifiers is of the category "OTHER".