Healthcare Provider Details

I. General information

NPI: 1164426417
Provider Name (Legal Business Name): DENISE GIANNASCOLI LINK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 3RD ST 482A
PHOENIX AZ
85004-2135
US

IV. Provider business mailing address

500 N 3RD ST 482A
PHOENIX AZ
85004-2135
US

V. Phone/Fax

Practice location:
  • Phone: 602-496-0893
  • Fax:
Mailing address:
  • Phone: 602-496-0893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN117498
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: