Healthcare Provider Details

I. General information

NPI: 1093226698
Provider Name (Legal Business Name): BRENDA RENEE JUNIOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 E THOMPSON PEAK PKWY STE 100
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

7920 E THOMPSON PEAK PKWY STE 100
SCOTTSDALE AZ
85255-7402
US

V. Phone/Fax

Practice location:
  • Phone: 480-666-5583
  • Fax:
Mailing address:
  • Phone: 480-661-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP10710
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10710
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: