Healthcare Provider Details

I. General information

NPI: 1235362104
Provider Name (Legal Business Name): CARTLYNE ALEXIS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6218 S 7TH ST
PHOENIX AZ
85042-4211
US

IV. Provider business mailing address

6218 S 7TH ST
PHOENIX AZ
85042-4211
US

V. Phone/Fax

Practice location:
  • Phone: 602-304-3117
  • Fax:
Mailing address:
  • Phone: 602-304-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN108330
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: