Healthcare Provider Details

I. General information

NPI: 1649995028
Provider Name (Legal Business Name): PRIMEGYN WOMENS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 100
GLENDALE AZ
85308-5665
US

IV. Provider business mailing address

20325 N 51ST AVE STE 100
GLENDALE AZ
85308-5665
US

V. Phone/Fax

Practice location:
  • Phone: 602-848-2520
  • Fax: 602-848-2026
Mailing address:
  • Phone: 602-848-2520
  • Fax: 602-848-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KELLY BILOF
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: WHNP-C
Phone: 602-848-2520