Healthcare Provider Details

I. General information

NPI: 1972715670
Provider Name (Legal Business Name): HEIDI PENCE PSYNP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 E MISSOURI AVE
PHOENIX AZ
85014-2663
US

IV. Provider business mailing address

5025 N CENTRAL AVE SUITE 402
PHOENIX AZ
85012-1520
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-7073
  • Fax: 402-434-6047
Mailing address:
  • Phone: 402-486-7073
  • Fax: 402-434-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: HEIDI PENCE
Title or Position: OWNER
Credential: RN
Phone: 402-486-7073