Healthcare Provider Details

I. General information

NPI: 1649897091
Provider Name (Legal Business Name): CAROLYNE N SIMIYU KARUKU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

2239 W BLAYLOCK DR
PHOENIX AZ
85085-8705
US

V. Phone/Fax

Practice location:
  • Phone: 602-249-0212
  • Fax:
Mailing address:
  • Phone: 702-738-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number240969
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberRN240969
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: