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General NPI Number Information
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NPI Number | 1770027179
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Entity Type | Organization
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Legal Business Name | PEDERSEN PRIMARY CARE, LLC
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 290 S ALMA SCHOOL RD # 5 A
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City | CHANDLER
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State | AZ
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Zip | 85224-7631
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Country | US
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Telephone | 480-659-5013
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Fax | 480-659-2057
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Provider Business Mailing Address
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Address Line | 290 S ALMA SCHOOL RD # 5 A
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City | CHANDLER
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State | AZ
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Zip | 85224-7631
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Country | US
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Telephone | 480-659-5013
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Fax | 480-659-2057
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Authorized Official
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Title or Position | FAMILY NURSE PRACTIONER/FNP
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Name | CAREN C PEDERSEN
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Credential | NP-C
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Telephone | 602-625-6286
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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 | AP7572
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License Number State | AZ
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