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NPI Code Detail

MEDICARE: MR. DAVID ALONZO CRESAP FNP-C

MEDICARE: MR. DAVID ALONZO CRESAP FNP-C
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
1363LF0000XFamily Nurse PractitionerAP10727AZ

General Provider Information

NPI Number : 1457863334
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID ALONZO CRESAP FNP-C
Provider Business Mailing Address
First Line : 2216 N ALMOND
Second Line :
City : MESA
State : AZ
Zip : 85213-2232
Country : US
Telephone Number : 602-315-9053
Fax Number :
Provider Business Practice Location Address
First Line : 2216 N ALMOND
Second Line :
City : MESA
State : AZ
Zip : 85213-2232
Country : US
Telephone Number : 602-315-9053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2017
Last Update Date : 10/31/2017

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