MEDICARE: SHELLEY BERGER DOOLEY APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN-034823	AZ

General Provider Information

NPI Number	:	1073622940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY BERGER DOOLEY APRN

Provider Business Mailing Address
First Line	:	11120 N TATUM BLVD
Second Line	:	SUITE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1628
Country	:	US
Telephone Number	:	602-443-2111
Fax Number	:	602-443-2110

Provider Business Practice Location Address
First Line	:	11120 N TATUM BLVD
Second Line	:	SUITE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1628
Country	:	US
Telephone Number	:	602-443-2111
Fax Number	:	602-443-2110

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/17/2015

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