MEDICARE: RAINA MAE ELPEDES FEUDO NP

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	363LF0000X	Family Nurse Practitioner	285540	AZ

General Provider Information

NPI Number	:	1043916497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAINA MAE ELPEDES FEUDO NP

Provider Business Mailing Address
First Line	:	2430 W RAY RD STE 3
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3552
Country	:	US
Telephone Number	:	480-626-6318
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 W RAY RD STE 3
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3552
Country	:	US
Telephone Number	:	480-626-6318
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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