Healthcare Provider Details

I. General information

NPI: 1265904775
Provider Name (Legal Business Name): DENISE TURNER'COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 S 39TH DR
PHOENIX AZ
85041-6002
US

IV. Provider business mailing address

7409 S 39TH DR
PHOENIX AZ
85041-6002
US

V. Phone/Fax

Practice location:
  • Phone: 602-314-6694
  • Fax: 602-314-6694
Mailing address:
  • Phone: 602-907-7378
  • Fax: 602-314-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number1860933
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: