MEDICARE: SIERRA FAYE PENA RN

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	163WI0500X	Infusion Therapy Registered Nurse	RN212941	AZ

General Provider Information

NPI Number	:	1356122493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA FAYE PENA RN

Provider Business Mailing Address
First Line	:	2525 N 53RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2603
Country	:	US
Telephone Number	:	928-551-2402
Fax Number	:

Provider Business Practice Location Address
First Line	:	7373 E SCOTTSDALE MALL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-4425
Country	:	US
Telephone Number	:	928-551-2402
Fax Number	:

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

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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