Healthcare Provider Details

I. General information

NPI: 1174022628
Provider Name (Legal Business Name): ALEXIS NORDVOLD-YOUNG SILENCE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E ROANOKE AVE STE 100
PHOENIX AZ
85004-1006
US

IV. Provider business mailing address

45 E ROANOKE AVE STE 100
PHOENIX AZ
85004-1006
US

V. Phone/Fax

Practice location:
  • Phone: 623-552-3745
  • Fax:
Mailing address:
  • Phone: 623-552-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10985
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: