Healthcare Provider Details

I. General information

NPI: 1518329218
Provider Name (Legal Business Name): JODI LEIGH NEWMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST SUITE 4010
PHOENIX AZ
85020-2437
US

IV. Provider business mailing address

9250 N 3RD ST SUITE 4010
PHOENIX AZ
85020-2437
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-3848
  • Fax: 602-633-3841
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8530
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: