Healthcare Provider Details

I. General information

NPI: 1265869598
Provider Name (Legal Business Name): SHELLY ROME N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 N POWER RD SUITE 118
MESA AZ
85215-2903
US

IV. Provider business mailing address

3514 N POWER RD SUITE 118
MESA AZ
85215-2903
US

V. Phone/Fax

Practice location:
  • Phone: 480-844-8346
  • Fax: 480-844-3889
Mailing address:
  • Phone: 480-844-8346
  • Fax: 480-844-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP0622
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN061491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: