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General NPI Number Information
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NPI Number | 1427764000
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Entity Type | Individual
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Provider Name | RACHEL SONGMIN CARROLL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 1933 W MAIN ST STE 1
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City | MESA
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State | AZ
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Zip | 85201-6930
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Country | US
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Telephone | 480-283-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 S CORRINE DR
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City | GILBERT
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State | AZ
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Zip | 85296-4154
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Country | US
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Telephone | 148-028-3533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 294002
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License Number State | AZ
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