Healthcare Provider Details

I. General information

NPI: 1164240347
Provider Name (Legal Business Name): AN NP FOR ME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15048 W YOUNG ST
SURPRISE AZ
85374-7484
US

IV. Provider business mailing address

13835 N TATUM BLVD STE 9120
PHOENIX AZ
85032-5581
US

V. Phone/Fax

Practice location:
  • Phone: 480-796-2730
  • Fax:
Mailing address:
  • Phone: 480-381-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELISA E DEHERRERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-381-5955