Healthcare Provider Details

I. General information

NPI: 1326436890
Provider Name (Legal Business Name): HEIDI NYHOFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4766 E. QUEEN CREEK
GILBERT AZ
85297
US

IV. Provider business mailing address

4766 E QUEEN CREEK RD
GILBERT AZ
85297-8005
US

V. Phone/Fax

Practice location:
  • Phone: 855-925-4733
  • Fax:
Mailing address:
  • Phone: 855-925-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8463
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: