Healthcare Provider Details

I. General information

NPI: 1245598010
Provider Name (Legal Business Name): DENISE MARIE DRAKE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE DRAKE LAWLESS PMHNP-BC

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 06/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 E INDIAN SCHOOL RD
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

7101 E INDIAN SCHOOL RD
SCOTTSDALE AZ
85251-3807
US

V. Phone/Fax

Practice location:
  • Phone: 480-946-1637
  • Fax: 480-941-9361
Mailing address:
  • Phone: 480-946-1637
  • Fax: 480-941-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4464
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: