Healthcare Provider Details

I. General information

NPI: 1194741801
Provider Name (Legal Business Name): BETH G RUMACK NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD EAST BUILDING
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BUILDING 2108, SUITE 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-1784
  • Fax: 602-546-1785
Mailing address:
  • Phone: 602-512-8029
  • Fax: 602-512-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number133214
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: