Healthcare Provider Details

I. General information

NPI: 1265679880
Provider Name (Legal Business Name): MARINDA VANROOYEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3347 E PARK AVE
GILBERT AZ
85234-4115
US

IV. Provider business mailing address

3347 E PARK AVE
GILBERT AZ
85234-4115
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-6301
  • Fax: 480-813-9011
Mailing address:
  • Phone: 480-926-6301
  • Fax: 480-813-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN115008
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: