MEDICARE: RUTH AYIYI FNP-C

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	AP11168	AZ

General Provider Information

NPI Number	:	1932605284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH AYIYI FNP-C

Provider Business Mailing Address
First Line	:	1806 N 114TH AVE
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-5235
Country	:	US
Telephone Number	:	602-885-7551
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7302
Country	:	US
Telephone Number	:	602-899-7774
Fax Number	:

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

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

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