Healthcare Provider Details

I. General information

NPI: 1740149509
Provider Name (Legal Business Name): THERESA REDMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 E CAMELBACK RD STE A215
PHOENIX AZ
85018-2897
US

IV. Provider business mailing address

6460 E MCDOWELL RD APT 1126
SCOTTSDALE AZ
85257-0004
US

V. Phone/Fax

Practice location:
  • Phone: 503-816-1532
  • Fax:
Mailing address:
  • Phone: 503-816-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number268297
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: