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General NPI Number Information
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NPI Number | 1881807790
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Entity Type | Individual
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Provider Name | BETSY LYNN DESJARLAIS FNP
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 3605 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85018-7505
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Country | US
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Telephone | 602-427-0779
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Fax | 602-275-1716
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Provider Business Mailing Address
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Address Line | 2311 N 58TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-1911
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Country | US
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Telephone | 719-963-0633
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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 | 4978
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License Number State | AZ
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