Healthcare Provider Details

I. General information

NPI: 1396096293
Provider Name (Legal Business Name): NICOLE STRUTZENBERG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 E BASELINE RD
MESA AZ
85209-5005
US

IV. Provider business mailing address

11052 E SERAFINA AVE
MESA AZ
85212-5193
US

V. Phone/Fax

Practice location:
  • Phone: 602-345-1192
  • Fax:
Mailing address:
  • Phone: 480-440-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017056
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4666
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: