Healthcare Provider Details

I. General information

NPI: 1659972040
Provider Name (Legal Business Name): HANAH ELISE ZEHNDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/02/2020
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: 623-536-5310
  • Fax:
Mailing address:
  • Phone: 623-536-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248150
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: