Provider Demographics
NPI:1346927365
Name:BROCK ANDERSEN, MARIAN (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:BROCK ANDERSEN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E THUNDERBIRD TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-8370
Mailing Address - Country:US
Mailing Address - Phone:623-243-3378
Mailing Address - Fax:
Practice Address - Street 1:502 E THUNDERBIRD TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-8370
Practice Address - Country:US
Practice Address - Phone:623-243-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2943252083B0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine