Individual provider Active NPI

Alice Banda, REGISTERED NURSE

  • Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1710853247
Registry record updated Oct 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
333310 Issued in AZ
Practice address
4824 E Baseline Rd Ste 133
Mesa, AZ 85206-4680
Phone
(480) 306-5650
NPI assigned
Oct 13, 2025
Last updated
Oct 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 333310 AZ Primary

Addresses

Primary practice location

4824 E Baseline Rd Ste 133
Mesa, AZ 85206-4680

Mailing address

4824 E Baseline Rd Ste 133
Mesa, AZ 85206-4680
Phone (480) 306-5650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260501003633 AZ Practitioner - Nurse Practitioner 7719455294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

22717 S Ellsword Rd
Suite B101
Queen Creek, AZ 85142-7572

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
333310AZMDNurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792454400000",
    "number": "1710853247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 E BASELINE RD STE 133",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064680",
            "telephone_number": "480-306-5650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4824 E BASELINE RD STE 133",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064680",
            "telephone_number": "480-306-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDA",
        "first_name": "ALICE",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-13",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "333310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.