Healthcare Provider Details

I. General information

NPI: 1821471624
Provider Name (Legal Business Name): COLLEEN MARIE POWER KUPKA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

IV. Provider business mailing address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

V. Phone/Fax

Practice location:
  • Phone: 480-589-3999
  • Fax: 480-546-5202
Mailing address:
  • Phone: 480-589-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN189383
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN189383
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP256830
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: