Healthcare Provider Details

I. General information

NPI: 1720022767
Provider Name (Legal Business Name): RYAN M MOBLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD STE 260
PHOENIX AZ
85028-6025
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-6800
  • Fax: 602-494-6803
Mailing address:
  • Phone: 480-245-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP1873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: