Basic Information
| Provider Information | |||||||||
| NPI: | 1811423262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FETT | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | AG-ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 N 7TH ST | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022543151 | ||||||||
| FaxNumber: | 6022569581 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 N 7TH ST | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022543151 | ||||||||
| FaxNumber: | 6022569581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2017 | ||||||||
| LastUpdateDate: | 05/04/2017 | ||||||||
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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 | 363LA2100X | AP10090 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.