Healthcare Provider Details

I. General information

NPI: 1487670196
Provider Name (Legal Business Name): MARGARET PUTMAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE 375
PHOENIX AZ
85013-3420
US

IV. Provider business mailing address

300 W CLARENDON AVE 375
PHOENIX AZ
85013-3420
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-4161
  • Fax: 602-274-3394
Mailing address:
  • Phone: 602-277-4161
  • Fax: 602-274-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number30403
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: