Healthcare Provider Details

I. General information

NPI: 1750735114
Provider Name (Legal Business Name): NATASHA GUHA NP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE SUITE 138
GLENDALE AZ
85308-1260
US

IV. Provider business mailing address

PO BOX 24981
BELFAST ME
04915-2000
US

V. Phone/Fax

Practice location:
  • Phone: 602-564-0078
  • Fax:
Mailing address:
  • Phone: 844-969-0686
  • Fax: 773-832-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8716
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP8716
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: