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General NPI Number Information
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NPI Number | 1649796343
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Entity Type | Organization
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Legal Business Name | IDEFY MEDICAL AESTHETICS LLC
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 10/08/2023
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Provider Practice Location Address
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Address Line | 1324 N FARRELL CT STE 109
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City | GILBERT
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State | AZ
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Zip | 85233-1945
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Country | US
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Telephone | 480-414-8941
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Fax |
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Provider Business Mailing Address
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Address Line | 22620 S 178TH PL
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City | GILBERT
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State | AZ
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Zip | 85298-8934
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Country | US
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Telephone | 480-414-8941
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. BETHANY LYNN JAMESON
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Credential | FNP
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Telephone | 480-414-8941
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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 | AP10272
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License Number State | AZ
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