Healthcare Provider Details

I. General information

NPI: 1346927365
Provider Name (Legal Business Name): MARIAN BROCK ANDERSEN DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E THUNDERBIRD TRL
PHOENIX AZ
85042-8370
US

IV. Provider business mailing address

502 E THUNDERBIRD TRL
PHOENIX AZ
85042-8370
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-3378
  • Fax:
Mailing address:
  • Phone: 623-243-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number294325
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number294325
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number294325
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: