Healthcare Provider Details

I. General information

NPI: 1508428368
Provider Name (Legal Business Name): REBECCA LANDON DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 W FOREST MEADOWS ST STE 140
FLAGSTAFF AZ
86001-7226
US

IV. Provider business mailing address

333 N DOBSON RD STE 15
CHANDLER AZ
85224-4412
US

V. Phone/Fax

Practice location:
  • Phone: 480-282-8336
  • Fax:
Mailing address:
  • Phone: 480-282-8336
  • Fax: 480-282-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number228548
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: