Healthcare Provider Details

I. General information

NPI: 1841813748
Provider Name (Legal Business Name): BRITTNIE C ABISHALOM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 E THOMAS RD STE 100
SCOTTSDALE AZ
85251-7033
US

IV. Provider business mailing address

16331 N 73RD DR
PEORIA AZ
85382-1827
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-0606
  • Fax:
Mailing address:
  • Phone: 480-795-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: