MEDICARE: PAMELA FAZEKAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP8989	AZ

General Provider Information

NPI Number	:	1063964658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA FAZEKAS

Provider Business Mailing Address
First Line	:	3201 W FEATHER SOUND DR
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-1007
Country	:	US
Telephone Number	:	623-399-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 W FEATHER SOUND DR
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-1007
Country	:	US
Telephone Number	:	623-399-0023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2016
Last Update Date	:	10/29/2016

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Directions to “ PAMELA FAZEKAS ” Practice Location

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