Healthcare Provider Details

I. General information

NPI: 1982391058
Provider Name (Legal Business Name): NADEZHDA IVANOVNA LIND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 W MEEKER BLVD
SUN CITY WEST AZ
85375-5284
US

IV. Provider business mailing address

1915 S 104TH DR
TOLLESON AZ
85353-1382
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3800
  • Fax: 623-546-9896
Mailing address:
  • Phone: 623-399-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number290672
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number290672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: