Healthcare Provider Details

I. General information

NPI: 1700130028
Provider Name (Legal Business Name): CHAD CARTER DANCE F-NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE 160
GLENDALE AZ
85308-5674
US

IV. Provider business mailing address

20325 N 51ST AVE 160
GLENDALE AZ
85308-5674
US

V. Phone/Fax

Practice location:
  • Phone: 623-466-6350
  • Fax: 602-358-8698
Mailing address:
  • Phone: 623-466-6350
  • Fax: 602-358-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4696
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: