MEDICARE: RAN MCBRYDE APN

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	219040	AZ

General Provider Information

NPI Number	:	1841760766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAN MCBRYDE APN

Provider Business Mailing Address
First Line	:	7801 N 177TH AVE
Second Line	:
City	:	WADDELL
State	:	AZ
Zip	:	85355-9379
Country	:	US
Telephone Number	:	602-980-7810
Fax Number	:

Provider Business Practice Location Address
First Line	:	21620 N 19TH AVE STE A6
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-2716
Country	:	US
Telephone Number	:	480-589-2890
Fax Number	:

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

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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