Provider Demographics
NPI:1740354265
Name:BRICKER, ANNAMARIE (NP)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:
Last Name:BRICKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNAMARIE
Other - Middle Name:
Other - Last Name:BRICKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2025 N 3RD ST
Mailing Address - Street 2:170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1471
Mailing Address - Country:US
Mailing Address - Phone:602-794-2312
Mailing Address - Fax:602-462-1186
Practice Address - Street 1:2025 N 3RD ST
Practice Address - Street 2:170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1471
Practice Address - Country:US
Practice Address - Phone:602-794-2312
Practice Address - Fax:602-462-1186
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN039809363LP0808X
AZRN039808363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR09303Medicare UPIN