Healthcare Provider Details

I. General information

NPI: 1225539877
Provider Name (Legal Business Name): DENIS BESSMERTNY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5552 W RED ROCK RIDGE ST
TUCSON AZ
85742-8120
US

IV. Provider business mailing address

5552 W RED ROCK RIDGE ST
TUCSON AZ
85742-8120
US

V. Phone/Fax

Practice location:
  • Phone: 480-747-1312
  • Fax:
Mailing address:
  • Phone: 480-747-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10888
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: