Healthcare Provider Details

I. General information

NPI: 1659830552
Provider Name (Legal Business Name): MADINAH SIMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 N 7TH AVE STE 307
PHOENIX AZ
85013-3080
US

IV. Provider business mailing address

4205 N 7TH AVE STE 307
PHOENIX AZ
85013-3080
US

V. Phone/Fax

Practice location:
  • Phone: 602-522-2595
  • Fax: 602-258-4996
Mailing address:
  • Phone: 602-522-2595
  • Fax: 602-258-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN148969
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN148969
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: