MEDICARE: BRITANY R KORMOS NP-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
1	363L00000X	Nurse Practitioner	AP4509	AZ

General Provider Information

NPI Number	:	1558617407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITANY R KORMOS NP-C

Provider Business Mailing Address
First Line	:	6859 E REMBRANDT AVE
Second Line	:	SUITE 117
City	:	MESA
State	:	AZ
Zip	:	85212-3628
Country	:	US
Telephone Number	:	480-632-1577
Fax Number	:	480-632-1574

Provider Business Practice Location Address
First Line	:	6859 E REMBRANDT AVE
Second Line	:	SUITE 117
City	:	MESA
State	:	AZ
Zip	:	85212-3628
Country	:	US
Telephone Number	:	480-632-1577
Fax Number	:	480-632-1574

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

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	12/29/2017

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