MEDICARE: RACHEL RAE DELFINO BRILES FNP-C

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	AP11780	AZ

General Provider Information

NPI Number	:	1063988178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL RAE DELFINO BRILES FNP-C

Provider Business Mailing Address
First Line	:	1308 N STOCKTON HILL RD STE A
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-5190
Country	:	US
Telephone Number	:	928-279-1686
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 E BEVERLY AVE STE 203
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3593
Country	:	US
Telephone Number	:	928-757-3133
Fax Number	:

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

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	10/16/2018

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