Healthcare Provider Details

I. General information

NPI: 1700333549
Provider Name (Legal Business Name): BETH ANDERSON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21220 N 83RD AVE
PEORIA AZ
85382-2436
US

IV. Provider business mailing address

6330 W THUNDERBIRD RD
GLENDALE AZ
85306-4002
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-5131
  • Fax: 623-487-5140
Mailing address:
  • Phone: 623-487-5189
  • Fax: 623-487-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN095593
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: