Healthcare Provider Details

I. General information

NPI: 1013093582
Provider Name (Legal Business Name): DANA WASSERMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 N 3RD ST SUITE 100
PHOENIX AZ
85020-2471
US

IV. Provider business mailing address

2500 W UTOPIA RD STE. 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 602-371-3100
  • Fax:
Mailing address:
  • Phone: 602-214-6148
  • Fax: 602-214-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN095682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: