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NPI Code Detail

MEDICARE: HEIDI PENCE PSYNP, INC

MEDICARE: HEIDI PENCE PSYNP, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse

General Provider Information

NPI Number : 1972715670
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEIDI PENCE PSYNP, INC
Provider Business Mailing Address
First Line : 5025 N CENTRAL AVE
Second Line : SUITE 402
City : PHOENIX
State : AZ
Zip : 85012-1520
Country : US
Telephone Number : 402-486-7073
Fax Number : 402-434-6047
Provider Business Practice Location Address
First Line : 1037 E MISSOURI AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-2663
Country : US
Telephone Number : 402-486-7073
Fax Number : 402-434-6047
Authorized Official
Title or Position : OWNER
Name : HEIDI PENCE
Credential : RN
Telephone Number : 402-486-7073
Provider Enumeration Date : 05/04/2007
Last Update Date : 08/22/2020

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