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General NPI Number Information
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NPI Number | 1124833363
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Entity Type | Individual
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Provider Name | BRENDON J SHIBLEY
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Gender | Male
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 585 N JUNIPER DR STE 150
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City | CHANDLER
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State | AZ
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Zip | 85226-2560
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Country | US
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Telephone | 480-499-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 875 W PECOS RD APT 2113
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City | CHANDLER
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State | AZ
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Zip | 85225-7613
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Country | US
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Telephone | 760-920-4214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 237599
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License Number State | AZ
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