MEDICARE: MS. TERESA MARIA MCCOY RN

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	163WS0200X	School Registered Nurse	RN130413	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902073851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA MARIA MCCOY RN

Provider Business Mailing Address
First Line	:	1723 E ELLIS DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7233
Country	:	US
Telephone Number	:	480-752-1931
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 N 27TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-5015
Country	:	US
Telephone Number	:	602-764-1722
Fax Number	:

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

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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