Healthcare Provider Details

I. General information

NPI: 1164666129
Provider Name (Legal Business Name): BONNIE M PHELPS PHD, HMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 N STEWART AVE
TUCSON AZ
85716-4449
US

IV. Provider business mailing address

616 N STEWART AVE
TUCSON AZ
85716-4449
US

V. Phone/Fax

Practice location:
  • Phone: 520-991-9490
  • Fax:
Mailing address:
  • Phone: 520-991-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: