Healthcare Provider Details

I. General information

NPI: 1659868776
Provider Name (Legal Business Name): BRENDA A. DONOVAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E CAMELBACK RD STE 180
PHOENIX AZ
85018-2396
US

IV. Provider business mailing address

10266 E KIVA AVE
MESA AZ
85209-1280
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-0484
  • Fax: 602-944-6882
Mailing address:
  • Phone: 480-299-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11159
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP11159
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: