MEDICARE: MS. GRETCHEN KARR SCHABER NURSE PRACTITIONER

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	RN055253	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN055253	OTHER	AZ	NURSE PRACTITIONER

General Provider Information

NPI Number	:	1235133059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRETCHEN KARR SCHABER NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 1907
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86002-1907
Country	:	US
Telephone Number	:	928-774-5533
Fax Number	:	928-774-7366

Provider Business Practice Location Address
First Line	:	77 W FOREST AVE
Second Line	:	STE 302
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-1481
Country	:	US
Telephone Number	:	928-214-0470
Fax Number	:	928-214-0477

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

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

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