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Individual

LICEETT PENA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
616 E SOUTHERN AVE STE 103, MESA, AZ 85204
(602) 569-3999
(602) 569-3887
Mailing address
1533 E WILLETTA ST, PHOENIX, AZ 85006-2935
(602) 569-3999
(602) 569-3887

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN182545
AZ
363LF0000X
Family Nurse Practitioner
Primary
AP11544
AZ

Other

Enumeration date
08/09/2017
Last updated
09/21/2018
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