Healthcare Provider Details

I. General information

NPI: 1407387442
Provider Name (Legal Business Name): JULIA ANNETTE KIEFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S MILL AVE STE 212
TEMPE AZ
85281-5664
US

IV. Provider business mailing address

7000 N 16TH ST # 120-228
PHOENIX AZ
85020-5512
US

V. Phone/Fax

Practice location:
  • Phone: 480-410-4128
  • Fax: 480-410-4130
Mailing address:
  • Phone: 480-410-4128
  • Fax: 480-480-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP10404
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10404
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN113054
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: