Provider Demographics
NPI:1407947104
Name:VANA, KIMBERLY D (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:VANA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 W UNION HILLS DRIVE
Mailing Address - Street 2:BLDG B SUITE 1000
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1096
Mailing Address - Country:US
Mailing Address - Phone:623-328-5908
Mailing Address - Fax:480-830-3901
Practice Address - Street 1:6320 W UNION HILLS DRIVE
Practice Address - Street 2:BLDG B SUITE 1000
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:623-328-5908
Practice Address - Fax:480-830-3901
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN036510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ720643Medicaid