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General NPI Number Information
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NPI Number | 1366803306
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Entity Type | Organization
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Legal Business Name | ANTHEM TOTAL HEALTH
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 41818 N VENTURE DR SUITE 150
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City | ANTHEM
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State | AZ
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Zip | 85086-3188
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Country | US
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Telephone | 623-428-1204
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Fax | 520-306-4877
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Provider Business Mailing Address
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Address Line | 41818 N VENTURE DR SUITE 150
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City | ANTHEM
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State | AZ
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Zip | 85086-3188
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Country | US
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Telephone | 623-428-1204
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Fax | 520-306-4877
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Authorized Official
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Title or Position | NP/ CO-OWNER
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Name | VERONCIA J FOX
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Credential | FNP
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Telephone | 602-705-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | AZ
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