Healthcare Provider Details

I. General information

NPI: 1821327149
Provider Name (Legal Business Name): ANDREA DIANNE REDMON DNP, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA DIANNE CAUGHREN

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

IV. Provider business mailing address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

V. Phone/Fax

Practice location:
  • Phone: 888-513-6044
  • Fax: 505-272-8060
Mailing address:
  • Phone: 888-513-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberNP23442
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP5636
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: