Healthcare Provider Details

I. General information

NPI: 1548104813
Provider Name (Legal Business Name): KORTNEY LYNN RAWAK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12751 W BELL RD STE 123
SURPRISE AZ
85378-9738
US

IV. Provider business mailing address

12751 W BELL RD STE 123
SURPRISE AZ
85378-9738
US

V. Phone/Fax

Practice location:
  • Phone: 623-688-2855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: