Healthcare Provider Details

I. General information

NPI: 1851681498
Provider Name (Legal Business Name): BERNADETTE MARIE ANDALKAR ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2011
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 S VINEYARD STE 142
MESA AZ
85210
US

IV. Provider business mailing address

6535 N 61ST ST
PARADISE VALLEY AZ
85253-4235
US

V. Phone/Fax

Practice location:
  • Phone: 480-330-6010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP4026
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP4026
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: