Healthcare Provider Details

I. General information

NPI: 1750354981
Provider Name (Legal Business Name): BELLENE E RACOWSKY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W INDIAN SCHOOL RD SUITE 1 AND 2
PHOENIX AZ
85033-2980
US

IV. Provider business mailing address

PO BOX 32950
PHOENIX AZ
85064-2950
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7122
  • Fax:
Mailing address:
  • Phone: 602-433-1822
  • Fax: 602-246-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1248
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: