Healthcare Provider Details

I. General information

NPI: 1366993685
Provider Name (Legal Business Name): PAMELA JOANN EDWARDS HAIRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD STE. C-300
GLENDALE AZ
85306-4660
US

IV. Provider business mailing address

5750 W THUNDERBIRD RD STE. C-300
GLENDALE AZ
85306-4660
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-2848
  • Fax: 602-938-4401
Mailing address:
  • Phone: 602-938-2848
  • Fax: 602-938-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN167471
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: