Healthcare Provider Details

I. General information

NPI: 1609552116
Provider Name (Legal Business Name): BEATRICE LEA KJELLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

6975 W KINGS AVE
PEORIA AZ
85382-3955
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-6810
  • Fax:
Mailing address:
  • Phone: 701-331-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number294254
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: