Healthcare Provider Details

I. General information

NPI: 1548804735
Provider Name (Legal Business Name): RANDY SAVAGEAU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD STE 3100
PHOENIX AZ
85032-2136
US

IV. Provider business mailing address

3805 E BELL RD STE 3100
PHOENIX AZ
85032-2136
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-8644
  • Fax: 602-606-5128
Mailing address:
  • Phone: 602-867-8644
  • Fax: 602-606-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN183312
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: