Healthcare Provider Details

I. General information

NPI: 1932267564
Provider Name (Legal Business Name): JENNIFER LYNN WOMELDORF-DUNN MSNED, RN, CPN, CNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD # 6-220
PHOENIX AZ
85017-1097
US

IV. Provider business mailing address

3033 E THUNDERBIRD RD APT 1094
PHOENIX AZ
85032-5684
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-8295
  • Fax:
Mailing address:
  • Phone: 602-471-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN150227
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN150227
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN150227
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN150227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: