Healthcare Provider Details

I. General information

NPI: 1063395465
Provider Name (Legal Business Name): ASHLEE NICOLE UDALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 S POWER RD STE 137
GILBERT AZ
85295-8490
US

IV. Provider business mailing address

38013 N FLANK RIDER WAY
QUEEN CREEK AZ
85140-0143
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-3600
  • Fax:
Mailing address:
  • Phone: 480-253-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number261865
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: