Healthcare Provider Details

I. General information

NPI: 1265571665
Provider Name (Legal Business Name): HEATHER ANNE CUCCHETTI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANNE INGRAM D.O.

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N 32ND ST STE 110
PHOENIX AZ
85018-3961
US

IV. Provider business mailing address

4400 N 32ND ST STE 110
PHOENIX AZ
85018-3961
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-9595
  • Fax: 602-956-3232
Mailing address:
  • Phone: 602-956-9595
  • Fax: 602-956-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number005713
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: