Healthcare Provider Details

I. General information

NPI: 1215411590
Provider Name (Legal Business Name): JEANETTE LADANGA LY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE VILLANUEVA LADANGA

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

IV. Provider business mailing address

9647 E SHARON DR
SCOTTSDALE AZ
85260-4495
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5152
  • Fax: 480-603-4147
Mailing address:
  • Phone: 702-985-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11601
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: