Healthcare Provider Details

I. General information

NPI: 1063029486
Provider Name (Legal Business Name): MAKENSEY BETH DURRANT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1684 E BOSTON ST STE 102
GILBERT AZ
85295-6220
US

IV. Provider business mailing address

5518 E HARMONY AVE
MESA AZ
85206-6756
US

V. Phone/Fax

Practice location:
  • Phone: 480-448-2411
  • Fax: 480-476-8718
Mailing address:
  • Phone: 801-899-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247003
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: