MEDICARE: MRS. GRACE E MCGILL NP-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	AP4212	AZ

General Provider Information

NPI Number	:	1114294584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE E MCGILL NP-C

Provider Business Mailing Address
First Line	:	7350 N 22ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4753
Country	:	US
Telephone Number	:	602-674-5797
Fax Number	:

Provider Business Practice Location Address
First Line	:	7350 N 22ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4753
Country	:	US
Telephone Number	:	602-674-5797
Fax Number	:

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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