Basic Information
| Provider Information | |||||||||
| NPI: | 1922089622 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORENDUFF | ||||||||
| FirstName: | F | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3411 N 5TH AVE | ||||||||
| Address2: | STE 209 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027890344 | ||||||||
| FaxNumber: | 6028707566 | ||||||||
| Practice Location | |||||||||
| Address1: | 3945 E PARADISE FALLS DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206156200 | ||||||||
| FaxNumber: | 5206156255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0000X | AP1506 | AZ | N | Nursing Service Providers | Registered Nurse | Wound Care | 363LF0000X | AP1506 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 772310 | 05 | AZ | MEDICAID |