Provider Demographics
NPI:1538628979
Name:BOND, LEEANN (MS, RD)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19646 N 27TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4027
Mailing Address - Country:US
Mailing Address - Phone:623-238-7726
Mailing Address - Fax:
Practice Address - Street 1:19646 N 27TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4027
Practice Address - Country:US
Practice Address - Phone:623-238-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered