Healthcare Provider Details

I. General information

NPI: 1174514111
Provider Name (Legal Business Name): SHERRY L BOOZ ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 3RD ST SUITE 300
PHOENIX AZ
85020-2439
US

IV. Provider business mailing address

9225 N 3RD ST SUITE 300
PHOENIX AZ
85020-2439
US

V. Phone/Fax

Practice location:
  • Phone: 602-445-0751
  • Fax: 602-424-8128
Mailing address:
  • Phone: 602-445-0751
  • Fax: 602-424-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP4683
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: