Healthcare Provider Details

I. General information

NPI: 1457870834
Provider Name (Legal Business Name): AMY JEAN TOLIVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 09/16/2017
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

7500 E DEER VALLEY RD UNIT 187
SCOTTSDALE AZ
85255-4871
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax: 602-222-6554
Mailing address:
  • Phone: 602-748-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN186430
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: