Healthcare Provider Details

I. General information

NPI: 1750001160
Provider Name (Legal Business Name): JODI ESCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 W ORANGEWOOD AVE
GLENDALE AZ
85305-1111
US

IV. Provider business mailing address

8990 W ORANGEWOOD AVE
GLENDALE AZ
85305-1111
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-5446
  • Fax:
Mailing address:
  • Phone: 623-412-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number254480
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: