Healthcare Provider Details

I. General information

NPI: 1528813219
Provider Name (Legal Business Name): ANDREW EARL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19820 N 7TH ST STE 140
PHOENIX AZ
85024-1691
US

IV. Provider business mailing address

6916 W VILLA THERESA DR
GLENDALE AZ
85308-8092
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-7763
  • Fax:
Mailing address:
  • Phone: 602-312-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN172749
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRNP315668
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: