Healthcare Provider Details

I. General information

NPI: 1821288655
Provider Name (Legal Business Name): MADELINE ANZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 W CENTERRA DR S
GOODYEAR AZ
85338-2956
US

IV. Provider business mailing address

PO BOX 907
BUCKEYE AZ
85326-0069
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-4800
  • Fax: 623-772-4820
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP041362
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: