Healthcare Provider Details

I. General information

NPI: 1346682119
Provider Name (Legal Business Name): AUDRA LYNN ZACHMAN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 03/07/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DRIVE
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DRIVE
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3682
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP5109
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: