Healthcare Provider Details

I. General information

NPI: 1942678933
Provider Name (Legal Business Name): ALICIA COLLEEN NANCE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD STE. 5800
PHOENIX AZ
85032
US

IV. Provider business mailing address

3805 E BELL RD STE 5800
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-6500
  • Fax: 236-899-0836
Mailing address:
  • Phone: 602-688-6500
  • Fax: 623-889-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA9881
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: