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General NPI Number Information
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NPI Number | 1720485717
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Entity Type | Individual
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Provider Name | BETHANY LEIGH BLONDE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 18591 N 59TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 480-403-1416
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Fax |
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Provider Business Mailing Address
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Address Line | 18591 N 59TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-1251
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Country | US
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Telephone | 480-403-1416
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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 | AP7464
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License Number State | AZ
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