MEDICARE: MRS. MARTA G MAROON 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	RN118742	AZ

General Provider Information

NPI Number	:	1902923469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTA G MAROON RN

Provider Business Mailing Address
First Line	:	1025 N COUNTRY CLUB DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3307
Country	:	US
Telephone Number	:	480-472-4204
Fax Number	:	480-472-4270

Provider Business Practice Location Address
First Line	:	828 S VALENCIA
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-2824
Country	:	US
Telephone Number	:	480-472-4204
Fax Number	:	480-472-4270

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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