Healthcare Provider Details

I. General information

NPI: 1649610338
Provider Name (Legal Business Name): AMY E FORKER B.S.N., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

5401 E VAN BUREN ST UNIT #2086
PHOENIX AZ
85008-3497
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-525-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN179761
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: