Healthcare Provider Details

I. General information

NPI: 1811763915
Provider Name (Legal Business Name): ELIZABETH ROTELLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ROTELLA

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E CHANDLER BLVD STE 308
PHOENIX AZ
85048-7646
US

IV. Provider business mailing address

4545 E CHANDLER BLVD STE 308
PHOENIX AZ
85048-7646
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax:
Mailing address:
  • Phone: 480-626-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number300686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: