Healthcare Provider Details

I. General information

NPI: 1912946591
Provider Name (Legal Business Name): KERI M SWEETEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 N 32ND STREET
PHOENIX AZ
85028
US

IV. Provider business mailing address

10255 N 32ND STREET
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-0661
  • Fax: 602-254-3474
Mailing address:
  • Phone: 602-393-0661
  • Fax: 602-254-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number23505
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: