Healthcare Provider Details

I. General information

NPI: 1780166439
Provider Name (Legal Business Name): AMY ALLISON STARKS RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15060 S 39TH ST
PHOENIX AZ
85044-6612
US

IV. Provider business mailing address

PO BOX 50924
PHOENIX AZ
85076-0924
US

V. Phone/Fax

Practice location:
  • Phone: 480-332-7336
  • Fax: 480-545-2673
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN166622
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: