Healthcare Provider Details

I. General information

NPI: 1073209276
Provider Name (Legal Business Name): ALLISON MARIE POPA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 06/08/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 N DYSART RD
GOODYEAR AZ
85395-2338
US

IV. Provider business mailing address

2840 N DYSART RD
GOODYEAR AZ
85395-2338
US

V. Phone/Fax

Practice location:
  • Phone: 623-536-5309
  • Fax:
Mailing address:
  • Phone: 623-536-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03230359
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: