Healthcare Provider Details

I. General information

NPI: 1326261777
Provider Name (Legal Business Name): CAROL BEMIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W FRYE RD
CHANDLER AZ
85224-6282
US

IV. Provider business mailing address

4622 E CARMEN ST
PHOENIX AZ
85044-5503
US

V. Phone/Fax

Practice location:
  • Phone: 480-728-3254
  • Fax:
Mailing address:
  • Phone: 602-530-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP1955
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP1955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: