MEDICARE: MARIE SOLANGE CEUS NP

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	AP10403	AZ

General Provider Information

NPI Number	:	1841719663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE SOLANGE CEUS NP

Provider Business Mailing Address
First Line	:	2889 E SANTA ROSA DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-1456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2889 E SANTA ROSA DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-1456
Country	:	US
Telephone Number	:	480-452-9892
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	09/13/2017

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