MEDICARE: MELODIE BARILLARO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	294293	AZ

General Provider Information

NPI Number	:	1013861962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODIE BARILLARO RN

Provider Business Mailing Address
First Line	:	4831 N 11TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-3681
Country	:	US
Telephone Number	:	602-424-2101
Fax Number	:	602-424-2103

Provider Business Practice Location Address
First Line	:	4831 N 11TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-3681
Country	:	US
Telephone Number	:	602-424-2101
Fax Number	:	602-424-2103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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