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General NPI Number Information
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NPI Number | 1992188965
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Entity Type | Individual
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Provider Name | MARINA KANDOVA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 20414 N 27TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-3250
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Country | US
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Telephone | 720-848-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 E LARK ST
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City | GILBERT
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State | AZ
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Zip | 85297-4582
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Country | US
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Telephone | 520-981-9372
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Fax | 472-203-3871
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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 | C-APN.0000373-C-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP9695
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License Number State | AZ
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