Healthcare Provider Details

I. General information

NPI: 1962559062
Provider Name (Legal Business Name): JEANNE ELLEN ANDERSON F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE STE800
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

33847 N 7TH ST
PHOENIX AZ
85085-7703
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax: 602-462-1186
Mailing address:
  • Phone: 623-582-1534
  • Fax: 623-582-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN041224
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: