Healthcare Provider Details

I. General information

NPI: 1821678640
Provider Name (Legal Business Name): SYDNEY MICHELLE OGDEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 05/26/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 E FARNESS DR STE 100
TUCSON AZ
85712-2141
US

IV. Provider business mailing address

5230 E FARNESS DR STE 100
TUCSON AZ
85712-2141
US

V. Phone/Fax

Practice location:
  • Phone: 520-444-6875
  • Fax:
Mailing address:
  • Phone: 520-318-9681
  • Fax: 520-325-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number254722
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: