Healthcare Provider Details

I. General information

NPI: 1548433246
Provider Name (Legal Business Name): GRETCHEN ANN ROZELLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E VAN BUREN ST BLDG F REHABILITATION
PHOENIX AZ
85008-6037
US

IV. Provider business mailing address

2500 E VAN BUREN ST BLDG F REHABILITATION
PHOENIX AZ
85008-6037
US

V. Phone/Fax

Practice location:
  • Phone: 602-220-6048
  • Fax: 602-629-7335
Mailing address:
  • Phone: 602-220-6048
  • Fax: 602-629-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN066258
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: