Healthcare Provider Details

I. General information

NPI: 1376517631
Provider Name (Legal Business Name): MARIE MCCORMICK ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD STE 3200
PHOENIX AZ
85032-2162
US

IV. Provider business mailing address

3815 E BELL RD STE 4500
PHOENIX AZ
85032-2171
US

V. Phone/Fax

Practice location:
  • Phone: 623-433-0202
  • Fax: 623-433-0204
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number299013
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: