Healthcare Provider Details

I. General information

NPI: 1265898795
Provider Name (Legal Business Name): JANET CUPONE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 W SANDRA TER
PHOENIX AZ
85053-3009
US

IV. Provider business mailing address

11209 N TATUM BLVD STE 180
PHOENIX AZ
85028-6016
US

V. Phone/Fax

Practice location:
  • Phone: 602-885-0354
  • Fax:
Mailing address:
  • Phone: 602-494-5155
  • Fax: 602-494-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8177
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: