Healthcare Provider Details

I. General information

NPI: 1083703045
Provider Name (Legal Business Name): JOELLEN BEARD EMBRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S DOBSON RD STE 203
MESA AZ
85202
US

IV. Provider business mailing address

3370 N HAYDEN RD # 123-215
SCOTTSDALE AZ
85251-6632
US

V. Phone/Fax

Practice location:
  • Phone: 480-376-2170
  • Fax: 480-699-0056
Mailing address:
  • Phone: 480-376-2170
  • Fax: 480-376-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN053123
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN053123
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP7036
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: