MEDICARE: JANE B NORTHERN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP4327	AZ
2	363LF0000X	Family Nurse Practitioner	APRN 1004	HI

General Provider Information

NPI Number	:	1154314169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE B NORTHERN FNP

Provider Business Mailing Address
First Line	:	20159 N SCOTTSDALE RD STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-0244
Country	:	US
Telephone Number	:	480-530-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	20159 N SCOTTSDALE RD STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-0244
Country	:	US
Telephone Number	:	480-530-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/09/2026

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