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General NPI Number Information
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NPI Number | 1740011923
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Entity Type | Individual
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Provider Name | JANE NA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 10/05/2024
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Provider Practice Location Address
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Address Line | 401 W BASELINE RD STE 108
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City | TEMPE
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State | AZ
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Zip | 85283-5349
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Country | US
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Telephone | 928-504-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W GROVE PKWY APT 1083
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City | TEMPE
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State | AZ
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Zip | 85283-4548
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Country | US
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Telephone | 602-500-1264
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 312692
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License Number State | AZ
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