Healthcare Provider Details

I. General information

NPI: 1336983840
Provider Name (Legal Business Name): JULIANE HAYASHI MSN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIANE FIDAZZO PMHNP

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 E PECOS RD STE 138
GILBERT AZ
85295-8053
US

IV. Provider business mailing address

4365 E PECOS RD STE 138
GILBERT AZ
85295-8053
US

V. Phone/Fax

Practice location:
  • Phone: 602-842-1625
  • Fax:
Mailing address:
  • Phone: 602-842-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number309275
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: