MEDICARE: MATTHEW J MCCONNELL FNP

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	363LF0000X	Family Nurse Practitioner	AP3837	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215238332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J MCCONNELL FNP

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:	520-818-3630

Provider Business Practice Location Address
First Line	:	12635 W RUDASILL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-9724
Country	:	US
Telephone Number	:	520-682-3777
Fax Number	:	520-682-2333

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	07/20/2015

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