MEDICARE: CAROL FILLIAN NP

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	363LA2200X	Adult Health Nurse Practitioner	AP1305	AZ

General Provider Information

NPI Number	:	1073507133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL FILLIAN NP

Provider Business Mailing Address
First Line	:	5750 W THUNDERBIRD RD
Second Line	:	C300
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4660
Country	:	US
Telephone Number	:	602-938-2848
Fax Number	:	602-938-4401

Provider Business Practice Location Address
First Line	:	5750 W THUNDERBIRD RD
Second Line	:	C300
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4660
Country	:	US
Telephone Number	:	602-938-2848
Fax Number	:	602-938-4401

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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