Provider Demographics
NPI:1780002139
Name:FANKHANEL, AMY REBECCA (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:REBECCA
Last Name:FANKHANEL
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:REBECCA
Other - Last Name:TUBRIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4530 E RAY RD STE 125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6096
Mailing Address - Country:US
Mailing Address - Phone:602-343-6167
Mailing Address - Fax:
Practice Address - Street 1:4530 E RAY RD STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6096
Practice Address - Country:US
Practice Address - Phone:602-343-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ256502363LW0102X, 363LW0102X
NDR29420363L00000X, 363LW0102X
MN5879363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner