Healthcare Provider Details

I. General information

NPI: 1780965897
Provider Name (Legal Business Name): DEBORAH A COONEY C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S COTTONWOOD DR
TEMPE AZ
85282-3014
US

IV. Provider business mailing address

6559 WILSON MILLS RD SUITE 106
MAYFIELD OH
44143-6402
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-4540
  • Fax:
Mailing address:
  • Phone: 440-449-1540
  • Fax: 440-460-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10796-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10796-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: