Healthcare Provider Details

I. General information

NPI: 1306789722
Provider Name (Legal Business Name): ISMITA DEMURO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

IV. Provider business mailing address

14441 N 57TH PL
SCOTTSDALE AZ
85254-3046
US

V. Phone/Fax

Practice location:
  • Phone: 833-242-0100
  • Fax:
Mailing address:
  • Phone: 480-263-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number337774
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: