MEDICARE: AMAN'S TELEHEALTH NP, LLC

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	363L00000X	Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023376993	OTHER	AZ	NPPES

General Provider Information

NPI Number	:	1871097121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAN'S TELEHEALTH NP, LLC

Provider Business Mailing Address
First Line	:	13794 W WADDELL RD # 203-131
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-8499
Country	:	US
Telephone Number	:	623-594-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	13794 W WADDELL RD # 203-131
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-8499
Country	:	US
Telephone Number	:	623-594-8589
Fax Number	:

Authorized Official
Title or Position	:	OWNER/EXECUTIVE MANAGER
Name	:	REESE AMAN
Credential	:	RN
Telephone Number	:	602-451-3440

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	03/21/2018

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