Healthcare Provider Details

I. General information

NPI: 1992336119
Provider Name (Legal Business Name): CHRISTINE S BOHANNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 465
PHOENIX AZ
85037-3357
US

IV. Provider business mailing address

9305 W THOMAS RD STE 465
PHOENIX AZ
85037-3357
US

V. Phone/Fax

Practice location:
  • Phone: 480-745-3547
  • Fax: 480-745-3548
Mailing address:
  • Phone: 480-745-3547
  • Fax: 480-745-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number238854
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number178842
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: