Healthcare Provider Details

I. General information

NPI: 1396159554
Provider Name (Legal Business Name): HEATHER JUNIPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W ELLIOT RD STE 103
GILBERT AZ
85233-5127
US

IV. Provider business mailing address

4925 E EMILE ZOLA AVE
SCOTTSDALE AZ
85254-3519
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2787
  • Fax: 480-545-1434
Mailing address:
  • Phone: 602-617-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5588
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: