Provider Demographics
NPI:1598207581
Name:BASCH, AMY (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BASCH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2219
Mailing Address - Country:US
Mailing Address - Phone:602-833-3199
Mailing Address - Fax:602-833-3190
Practice Address - Street 1:901 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2219
Practice Address - Country:US
Practice Address - Phone:602-833-3199
Practice Address - Fax:602-833-3190
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ264991Medicaid