Healthcare Provider Details

I. General information

NPI: 1144356056
Provider Name (Legal Business Name): GLENDA MARTYNE BLANCHARD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 E INDIAN SCHOOL RD SUITE 100
PHOENIX AZ
85018-5500
US

IV. Provider business mailing address

4840 E INDIAN SCHOOL RD SUITE 100
PHOENIX AZ
85018-5500
US

V. Phone/Fax

Practice location:
  • Phone: 602-508-2900
  • Fax: 602-952-9432
Mailing address:
  • Phone: 602-508-2900
  • Fax: 602-952-9432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN085044
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: