MEDICARE: MADISON SCHOOL DISTRICT #38

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	163WS0200X	School Registered Nurse	RN048031	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245378264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON SCHOOL DISTRICT #38

Provider Business Mailing Address
First Line	:	5601 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2903
Country	:	US
Telephone Number	:	602-664-7900
Fax Number	:	602-664-7999

Provider Business Practice Location Address
First Line	:	2002 E CAMPBELL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5521
Country	:	US
Telephone Number	:	602-664-7220
Fax Number	:	602-664-7299

Authorized Official
Title or Position	:	SCHOOL NURSE
Name	:	MRS. DIANA QUALLE DELLIS
Credential	:	R.N., B.S.N.
Telephone Number	:	602-664-7220

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/13/2008

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Directions to “MADISON SCHOOL DISTRICT #38 ” Practice Location

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