Provider Demographics
NPI:1245330224
Name:PENCE, HEIDI (APRN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:PENCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6380 EAST THOMAS ROAD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-949-1100
Mailing Address - Fax:480-949-1150
Practice Address - Street 1:1037 E MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2663
Practice Address - Country:US
Practice Address - Phone:602-393-2373
Practice Address - Fax:602-393-2374
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN-087676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q41802Medicare UPIN