Healthcare Provider Details

I. General information

NPI: 1194392951
Provider Name (Legal Business Name): BRITTANY BONFIELD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 E GUADALUPE RD
TEMPE AZ
85283-2911
US

IV. Provider business mailing address

PO BOX 746093
ATLANTA GA
30374-6093
US

V. Phone/Fax

Practice location:
  • Phone: 480-618-0123
  • Fax: 520-300-8051
Mailing address:
  • Phone: 773-352-1517
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRNP258420
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number258420
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number258420
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRNP258420
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: