MEDICARE: MRS. SANDRA BANFILL 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	363LA2100X	Acute Care Nurse Practitioner	AP5510	AZ

General Provider Information

NPI Number	:	1720407885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA BANFILL NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 17779
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85011-0779
Country	:	US
Telephone Number	:	602-374-7522
Fax Number	:	602-237-6997

Provider Business Practice Location Address
First Line	:	2700 N 3RD ST STE 3045
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-4627
Country	:	US
Telephone Number	:	602-374-7522
Fax Number	:	602-237-6997

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/19/2016

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