Healthcare Provider Details

I. General information

NPI: 1205280757
Provider Name (Legal Business Name): BRIANA HUPE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 N 37TH AVE
PHOENIX AZ
85019-3206
US

IV. Provider business mailing address

4510 N 37TH AVE
PHOENIX AZ
85019-3206
US

V. Phone/Fax

Practice location:
  • Phone: 602-336-2920
  • Fax:
Mailing address:
  • Phone: 602-336-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN185909
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: