Healthcare Provider Details

I. General information

NPI: 1093922544
Provider Name (Legal Business Name): HEATHER RETH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

3003 NORTH CENTRAL AVE SUITE 800
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax: 877-343-6593
Mailing address:
  • Phone: 602-462-1132
  • Fax: 877-343-6593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103128/AP 4658
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: