Healthcare Provider Details

I. General information

NPI: 1649653668
Provider Name (Legal Business Name): HEATHER BAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W BELL RD
PHOENIX AZ
85023-3507
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 602-588-3800
  • Fax: 602-588-3764
Mailing address:
  • Phone: 623-277-1130
  • Fax: 602-906-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: