Healthcare Provider Details

I. General information

NPI: 1407208135
Provider Name (Legal Business Name): SONJA KERTH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

7975 N HAYDEN RD STE D354
SCOTTSDALE AZ
85258-3243
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5155
  • Fax: 602-494-5115
Mailing address:
  • Phone: 480-214-9720
  • Fax: 480-214-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP8801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: