Provider Demographics
NPI:1245029925
Name:HEARNS, JOAN BROCKWAY (RDN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:BROCKWAY
Last Name:HEARNS
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16043 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2828
Mailing Address - Country:US
Mailing Address - Phone:623-533-1965
Mailing Address - Fax:
Practice Address - Street 1:16043 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2828
Practice Address - Country:US
Practice Address - Phone:623-533-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered