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General NPI Number Information
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NPI Number | 1235304031
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Entity Type | Individual
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Provider Name | SIDDIQUI ROSE HERNANDEZ CRNP PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 123 E BASELINE RD STE D104
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City | TEMPE
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State | AZ
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Zip | 85283-1291
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Country | US
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Telephone | 480-718-0568
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17779
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City | PHOENIX
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State | AZ
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Zip | 85011-0779
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Country | US
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Telephone | 480-718-0568
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN213648
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2010039446
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R205786
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP11103
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License Number State | AZ
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