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NPI Code Detail

MEDICARE: PRIYA SABUMON BALAN RN

MEDICARE: PRIYA SABUMON BALAN RN
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
1163WM0705XMedical-Surgical Registered NurseRN214133AZ
2363L00000XNurse Practitioner271815AZ
3363LF0000XFamily Nurse Practitioner271815AZ
4363LP0808XPsychiatric/Mental Health Nurse Practitioner271815AZ

General Provider Information

NPI Number : 1366015067
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRIYA SABUMON BALAN RN
Provider Business Mailing Address
First Line : 6677 W THUNDERBIRD RD STE I164
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-3762
Country : US
Telephone Number : 623-878-2100
Fax Number : 623-776-9419
Provider Business Practice Location Address
First Line : 6677 W THUNDERBIRD RD STE I164
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-3762
Country : US
Telephone Number : 623-878-2100
Fax Number : 623-776-9419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2021
Last Update Date : 06/03/2026

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