Healthcare Provider Details

I. General information

NPI: 1710853247
Provider Name (Legal Business Name): ALICE BANDA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 S BETTY ST
GILBERT AZ
85295-0359
US

IV. Provider business mailing address

2570 S BETTY ST
GILBERT AZ
85295-0359
US

V. Phone/Fax

Practice location:
  • Phone: 480-370-9833
  • Fax:
Mailing address:
  • Phone: 480-370-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number333310
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: