Individual
BERTA LEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, ANP-BC
Contact information
Practice address
6333 N 12TH ST UNIT 151, PHOENIX, AZ 85014-1314
(602) 730-0307
Mailing address
6333 N 12TH ST UNIT 151, PHOENIX, AZ 85014-1314
(602) 730-0307
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN053220
AZ
363LA2200X
Adult Health Nurse Practitioner
Primary
AP3180
AZ
Other
Enumeration date
10/03/2009
Last updated
10/24/2013
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