Healthcare Provider Details

I. General information

NPI: 1821376526
Provider Name (Legal Business Name): WENDY LYNN RYNES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W BASELINE RD
PHOENIX AZ
85041-6492
US

IV. Provider business mailing address

4600 S MILL AVE #280
TEMPE AZ
85282-6757
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 480-677-8283
Mailing address:
  • Phone: 480-305-2888
  • Fax: 480-305-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP4141
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: