Healthcare Provider Details

I. General information

NPI: 1598432452
Provider Name (Legal Business Name): HIMANI R SULLHAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E CHAUNCEY LN STE 225
PHOENIX AZ
85054-3117
US

IV. Provider business mailing address

7010 E CHAUNCEY LN STE 225
PHOENIX AZ
85054-3117
US

V. Phone/Fax

Practice location:
  • Phone: 480-585-5200
  • Fax: 480-585-5233
Mailing address:
  • Phone: 480-585-5200
  • Fax: 480-585-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number238454
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number238454
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: