Healthcare Provider Details

I. General information

NPI: 1790845691
Provider Name (Legal Business Name): KATHY L BONDIETTI-ODELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33606 N 60TH ST
SCOTTSDALE AZ
85262-5243
US

IV. Provider business mailing address

27970 N 61ST PL
SCOTTSDALE AZ
85262-8740
US

V. Phone/Fax

Practice location:
  • Phone: 480-575-2000
  • Fax: 480-488-7055
Mailing address:
  • Phone: 480-575-2902
  • Fax: 480-502-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN049065
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: