Provider Demographics
NPI:1912146325
Name:SCANES, CHARMAIGNE (FNP)
Entity Type:Individual
Prefix:
First Name:CHARMAIGNE
Middle Name:
Last Name:SCANES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHARMAIGNE
Other - Middle Name:
Other - Last Name:SCANES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN,MSN,APRNRNP FNP
Mailing Address - Street 1:1050 NORTH FAIRWAY DRIVE
Mailing Address - Street 2:BUILDING C SUITE 103
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8585
Mailing Address - Country:US
Mailing Address - Phone:845-337-9665
Mailing Address - Fax:833-527-1531
Practice Address - Street 1:9225 N 3RD ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2455
Practice Address - Country:US
Practice Address - Phone:602-362-2983
Practice Address - Fax:480-565-4552
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ243834363LF0000X
NYF346893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAPRN-RNP243834OtherAZBN