Healthcare Provider Details

I. General information

NPI: 1376069435
Provider Name (Legal Business Name): BRENDA LEA SCHILK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2017
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 408
PHOENIX AZ
85027
US

IV. Provider business mailing address

19636 N 27TH AVE STE 408
PHOENIX AZ
85027-4021
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-0100
  • Fax:
Mailing address:
  • Phone: 623-780-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP10423
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP10423
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP10423
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: