Healthcare Provider Details

I. General information

NPI: 1134140064
Provider Name (Legal Business Name): JUDITH ANNE NEWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH ANNE HELLER NP

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 E BROADWAY RD STE 107
MESA AZ
85206-1346
US

IV. Provider business mailing address

5151 E BROADWAY RD STE 107
MESA AZ
85206-1346
US

V. Phone/Fax

Practice location:
  • Phone: 480-290-7000
  • Fax: 480-325-3461
Mailing address:
  • Phone: 480-290-7000
  • Fax: 602-254-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN067066
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP0391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: