MEDICARE: MAUREEN KEIGHER HARRISON F.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	363LF0000X	Family Nurse Practitioner	RN043185	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ014299	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1831191329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN KEIGHER HARRISON F.N.P.

Provider Business Mailing Address
First Line	:	5519 S COMPASS RD
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1932
Country	:	US
Telephone Number	:	480-831-6738
Fax Number	:	480-831-6759

Provider Business Practice Location Address
First Line	:	8117 E ROOSEVELT ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-3818
Country	:	US
Telephone Number	:	480-941-9283
Fax Number	:	480-941-9286

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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