Healthcare Provider Details

I. General information

NPI: 1669951836
Provider Name (Legal Business Name): ANGELA R ALLEN-ZAUGG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9115 E BASELINE RD STE 103
MESA AZ
85209-7764
US

IV. Provider business mailing address

9115 E BASELINE RD STE 103
MESA AZ
85209-7764
US

V. Phone/Fax

Practice location:
  • Phone: 480-202-4611
  • Fax:
Mailing address:
  • Phone: 480-202-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number316752
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN109702
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: