Healthcare Provider Details

I. General information

NPI: 1366803306
Provider Name (Legal Business Name): ANTHEM TOTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41818 N VENTURE DR SUITE 150
ANTHEM AZ
85086-3188
US

IV. Provider business mailing address

41818 N VENTURE DR SUITE 150
ANTHEM AZ
85086-3188
US

V. Phone/Fax

Practice location:
  • Phone: 623-428-1204
  • Fax: 520-306-4877
Mailing address:
  • Phone: 623-428-1204
  • Fax: 520-306-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateAZ

VIII. Authorized Official

Name: VERONCIA J FOX
Title or Position: NP/ CO-OWNER
Credential: FNP
Phone: 602-705-5117