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General NPI Number Information
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NPI Number | 1619581634
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Entity Type | Individual
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Provider Name | MAYRA VANESSA ALVARADO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 2420 W BASELINE RD
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City | TEMPE
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State | AZ
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Zip | 85283-1040
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Country | US
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Telephone | 480-262-4195
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4534
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City | MESA
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State | AZ
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Zip | 85211-4534
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Country | US
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Telephone | 480-262-4195
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 247217
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License Number State | AZ
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