Healthcare Provider Details

I. General information

NPI: 1568375624
Provider Name (Legal Business Name): MRS. EMILY ANNE VISCONTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S 63RD ST
MESA AZ
85206-1618
US

IV. Provider business mailing address

143 S 63RD ST SUITE 100, 200 & 201
MESA AZ
85206-1618
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-6100
  • Fax: 480-461-4243
Mailing address:
  • Phone: 480-835-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRNP346219
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: