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General NPI Number Information
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NPI Number | 1538617147
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Entity Type | Individual
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Provider Name | WITEH BOSAMBE ESOE
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Gender | Female
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 4921 E BELL RD STE 205
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6002
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Country | US
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Telephone | 800-640-3451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1200
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-1200
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Country | US
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Telephone | 800-640-3451
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN-232548-2
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 260162
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License Number State | AZ
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