Healthcare Provider Details

I. General information

NPI: 1720506389
Provider Name (Legal Business Name): ERIN LYNNE CODY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 E ARBOR AVE STE 101
MESA AZ
85206-6102
US

IV. Provider business mailing address

3260 N HAYDEN RD STE 112
SCOTTSDALE AZ
85251-6650
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-1700
  • Fax: 480-396-3659
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: