Healthcare Provider Details

I. General information

NPI: 1205662517
Provider Name (Legal Business Name): CELIA BENTZ PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 W PALM LN
PHOENIX AZ
85037-4403
US

IV. Provider business mailing address

14240 N 22ND ST
PHOENIX AZ
85022-4603
US

V. Phone/Fax

Practice location:
  • Phone: 623-388-3216
  • Fax:
Mailing address:
  • Phone: 480-430-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number205510
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number307444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: