MEDICARE: SHEILA J ZOLLICOFFER-MANLEY 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	363L00000X	Nurse Practitioner	090206	AZ

General Provider Information

NPI Number	:	1235195470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA J ZOLLICOFFER-MANLEY NP

Provider Business Mailing Address
First Line	:	1441 N 12TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 W SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-4716
Country	:	US
Telephone Number	:	480-512-3000
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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