Provider Demographics
NPI:1730859794
Name:NG, ANITA RAY (FDN-P)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:RAY
Last Name:NG
Suffix:
Gender:F
Credentials:FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 E CAMELBACK RD # 2140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:602-492-2324
Mailing Address - Fax:
Practice Address - Street 1:2637 E BIGHORN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8983
Practice Address - Country:US
Practice Address - Phone:602-492-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach