Healthcare Provider Details

I. General information

NPI: 1710177308
Provider Name (Legal Business Name): AIMEE HALVORSEN RN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16560 N DYSART RD
SURPRISE AZ
85374-3717
US

IV. Provider business mailing address

12550 W THUNDERBIRD RD SUITE 102
EL MIRAGE AZ
85335-4918
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-2294
  • Fax: 623-544-3210
Mailing address:
  • Phone: 623-556-8860
  • Fax: 623-876-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2071-0117
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: