Healthcare Provider Details

I. General information

NPI: 1790867349
Provider Name (Legal Business Name): DALISA BARQUERO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E BASELINE RD
PHOENIX AZ
85042-6530
US

IV. Provider business mailing address

303 E BASELINE RD
PHOENIX AZ
85042-6530
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 602-276-4427
Mailing address:
  • Phone: 602-243-7277
  • Fax: 602-276-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146353
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNP 06743
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN60740487
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60740488
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP2749
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: