Provider Demographics
NPI:1861736464
Name:GEISLER, BRENDA FAITH (FNP-C)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:FAITH
Last Name:GEISLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18404 N TATUM BLVD
Mailing Address - Street 2:STE 101C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1511
Mailing Address - Country:US
Mailing Address - Phone:602-485-7475
Mailing Address - Fax:
Practice Address - Street 1:6702 W BETHANY HOME RD STE 1314&15
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-4402
Practice Address - Country:US
Practice Address - Phone:623-435-7000
Practice Address - Fax:623-435-3947
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ170953OtherMEDICARE PTAN
AZ726145Medicaid