1902897168 NPI number — MS. ANN MARIE GUTHERY PSY NP

Table of content: DR. ALICE MARIE NOVELLO PH.D. (NPI 1013058072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902897168 NPI number — MS. ANN MARIE GUTHERY PSY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTHERY
Provider First Name:
ANN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PSY NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PROPP
Provider Other First Name:
ANN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902897168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 E. THOMAS ROAD
Provider Second Line Business Mailing Address:
AMBULATORY BUILDING, 4TH FLOOR
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-933-0990
Provider Business Mailing Address Fax Number:
601-933-4251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 N 31ST AVE
Provider Second Line Business Practice Location Address:
A-105
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85051-9582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-843-0000
Provider Business Practice Location Address Fax Number:
602-997-1305
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  064049 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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