Healthcare Provider Details

I. General information

NPI: 1073507133
Provider Name (Legal Business Name): CAROL FILLIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD C300
GLENDALE AZ
85306-4660
US

IV. Provider business mailing address

5750 W THUNDERBIRD RD C300
GLENDALE AZ
85306-4660
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-2848
  • Fax: 602-938-4401
Mailing address:
  • Phone: 602-938-2848
  • Fax: 602-938-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP1305
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: