Healthcare Provider Details

I. General information

NPI: 1932809225
Provider Name (Legal Business Name): SANDRAH NANZIRI REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRAH KAASA NANZIRI REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 N 73RD DR
PHOENIX AZ
85035-3253
US

IV. Provider business mailing address

2629 N 73RD DR
PHOENIX AZ
85035-3253
US

V. Phone/Fax

Practice location:
  • Phone: 857-407-9104
  • Fax:
Mailing address:
  • Phone: 857-407-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2318904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: