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General NPI Number Information
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NPI Number | 1710229406
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Entity Type | Individual
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Provider Name | JAMIE BOHANNON APRN-RX
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Gender | Female
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 59 S HIBBERT
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City | MESA
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State | AZ
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Zip | 85210-1414
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Country | US
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Telephone | 480-344-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 6722 E AIRE LIBRE LN
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5660
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Country | US
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Telephone | 602-326-2659
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1523
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License Number State | HI
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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 | AP4999
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License Number State | AZ
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