Healthcare Provider Details

I. General information

NPI: 1841437910
Provider Name (Legal Business Name): ANNA LOUISE BJORGUM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 W COMMERCE CT
TUCSON AZ
85746-6016
US

IV. Provider business mailing address

82 S STONE AVE
TUCSON AZ
85701-1713
US

V. Phone/Fax

Practice location:
  • Phone: 520-881-1347
  • Fax:
Mailing address:
  • Phone: 520-792-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN078672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: