Healthcare Provider Details

I. General information

NPI: 1598098055
Provider Name (Legal Business Name): MARY RINSEM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4658 E KELLY DR
GILBERT AZ
85234-0215
US

IV. Provider business mailing address

4658 E KELLY DR
GILBERT AZ
85234-0215
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-0015
  • Fax: 480-855-3542
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN153754
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: