Healthcare Provider Details

I. General information

NPI: 1538597885
Provider Name (Legal Business Name): LYNN PREUDHOMME ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W BELL RD
PHOENIX AZ
85053-3059
US

IV. Provider business mailing address

635 E BASELINE RD
PHOENIX AZ
85042-6551
US

V. Phone/Fax

Practice location:
  • Phone: 615-425-4200
  • Fax:
Mailing address:
  • Phone: 602-243-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5253
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP5253
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: