Healthcare Provider Details

I. General information

NPI: 1235681925
Provider Name (Legal Business Name): BRENDON DUANE BAERG FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 E CAREFREE HWY STE 106
CAVE CREEK AZ
85331-4742
US

IV. Provider business mailing address

4705 E CAREFREE HWY STE 106
CAVE CREEK AZ
85331-4742
US

V. Phone/Fax

Practice location:
  • Phone: 480-575-1142
  • Fax: 480-575-6781
Mailing address:
  • Phone: 480-575-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9031
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: