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General NPI Number Information
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NPI Number | 1831380781
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Entity Type | Organization
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Legal Business Name | ARIZONA MEDICAL BOUTIQUE LLC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 8360 E RAINTREE DR STE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2677
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Country | US
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Telephone | 480-766-0550
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Fax | 602-795-2445
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Provider Business Mailing Address
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Address Line | 8360 E RAINTREE DR STE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2677
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Country | US
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Telephone | 480-766-0550
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Fax | 602-795-2445
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Authorized Official
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Title or Position | OWNER
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Name | MISS SHUREE K OLDEHOEFT
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Credential | PA
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Telephone | 480-766-0550
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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 | 3164
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License Number State | AZ
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