Provider Demographics
NPI:1376225763
Name:FACURIB, JENNIFER NODERAMA (APRN FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NODERAMA
Last Name:FACURIB
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E CAMELBACK RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2396
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:
Practice Address - Street 1:655 S DOBSON RD
Practice Address - Street 2:STE 214
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-857-2381
Practice Address - Fax:480-857-2407
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ295649363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner