Healthcare Provider Details

I. General information

NPI: 1477875474
Provider Name (Legal Business Name): ALLISON NICHOLE WOODWORTH F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E WARNER RD SUITE 107
TEMPE AZ
85284-3224
US

IV. Provider business mailing address

1001 E WARNER RD SUITE 107
TEMPE AZ
85284-3224
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-3300
  • Fax: 602-889-5834
Mailing address:
  • Phone: 480-897-3300
  • Fax: 480-897-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: