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General NPI Number Information
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NPI Number | 1619476389
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Entity Type | Individual
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Provider Name | ANNA MARIE FUDER-BOEHM APRN
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Gender | Female
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 40 E MITCHELL DR
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City | PHOENIX
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State | AZ
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Zip | 85012-2330
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Country | US
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Telephone | 602-264-4331
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Fax | 602-264-4095
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Provider Business Mailing Address
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Address Line | 2266 S DOBSON RD STE 200
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City | MESA
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State | AZ
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Zip | 85202-6412
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 112408
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License Number State | NE
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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 | 2041
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License Number State | NE
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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 | 277703
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License Number State | AZ
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