Healthcare Provider Details

I. General information

NPI: 1750167698
Provider Name (Legal Business Name): RENEE GEBREMARIAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 N CAMPBELL AVE
TUCSON AZ
85719-1534
US

IV. Provider business mailing address

2042 E MABEL ST
TUCSON AZ
85719-4343
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-4650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number293517
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: