Healthcare Provider Details

I. General information

NPI: 1306847686
Provider Name (Legal Business Name): ELAINE RUTH HENSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINE RUTH BROSIOUS-HENSON ANP

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/24/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15333 N PIMA RD STE 305
SCOTTSDALE AZ
85260-2717
US

IV. Provider business mailing address

4264 FEATHER AVE
SAN DIEGO CA
92117-5531
US

V. Phone/Fax

Practice location:
  • Phone: 887-318-9948
  • Fax:
Mailing address:
  • Phone: 928-208-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAZNP54
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number16376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: