Healthcare Provider Details

I. General information

NPI: 1972826436
Provider Name (Legal Business Name): THERESA RODZEVIK RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST HOSPITAL DRIVE
WHITERIVER AZ
85941
US

IV. Provider business mailing address

3146 E COOLIDGE ST
PHOENIX AZ
85016-5070
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-4911
  • Fax:
Mailing address:
  • Phone: 703-402-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4329
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001190377
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: