Provider Demographics
NPI:1114745395
Name:SCAFEDE, HEATHER BROOKE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE
Last Name:SCAFEDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 W WING TIP DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4689
Mailing Address - Country:US
Mailing Address - Phone:520-360-1516
Mailing Address - Fax:
Practice Address - Street 1:7995 W TWIN PEAKS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-8137
Practice Address - Country:US
Practice Address - Phone:520-579-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN150370163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool