Healthcare Provider Details

I. General information

NPI: 1356122493
Provider Name (Legal Business Name): SIERRA FAYE PENA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 E SCOTTSDALE MALL
SCOTTSDALE AZ
85251-4425
US

IV. Provider business mailing address

2525 N 53RD ST
PHOENIX AZ
85008-2603
US

V. Phone/Fax

Practice location:
  • Phone: 928-551-2402
  • Fax:
Mailing address:
  • Phone: 928-551-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN212941
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: