Healthcare Provider Details

I. General information

NPI: 1366091274
Provider Name (Legal Business Name): TANIS AIKEN-SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16440 S 32ND ST
PHOENIX AZ
85048-7807
US

IV. Provider business mailing address

11633 S WARPAINT DR
PHOENIX AZ
85044-3460
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-7936
  • Fax:
Mailing address:
  • Phone: 602-882-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN095548
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: