MEDICARE: JENNIFER BRODIE N.P.

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	363LP0200X	Pediatric Nurse Practitioner	RN102819	AZ

General Provider Information

NPI Number	:	1821099029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BRODIE N.P.

Provider Business Mailing Address
First Line	:	7425 E SHEA BLVD
Second Line	:	SUITE 101
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6411
Country	:	US
Telephone Number	:	480-609-8100
Fax Number	:	480-609-8101

Provider Business Practice Location Address
First Line	:	7425 E SHEA BLVD
Second Line	:	SUITE 101
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6411
Country	:	US
Telephone Number	:	480-609-8100
Fax Number	:	480-609-8101

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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