Healthcare Provider Details

I. General information

NPI: 1255821260
Provider Name (Legal Business Name): RACHEL PETRUS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10238 E HAMPTON AVE STE 504
MESA AZ
85209-3321
US

IV. Provider business mailing address

7525 E BROADWAY RD STE 11
MESA AZ
85208-1156
US

V. Phone/Fax

Practice location:
  • Phone: 480-773-2220
  • Fax: 480-889-1574
Mailing address:
  • Phone: 480-945-4343
  • Fax: 480-945-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number340407
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number58320
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: