Provider Demographics
NPI:1215411590
Name:LY, JEANETTE LADANGA (FNP-BC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LADANGA
Last Name:LY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:VILLANUEVA
Other - Last Name:LADANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9647 E SHARON DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4495
Mailing Address - Country:US
Mailing Address - Phone:702-985-4647
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 100
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2467
Practice Address - Country:US
Practice Address - Phone:480-304-5152
Practice Address - Fax:480-603-4147
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily