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NPI Code Detail

MEDICARE: MARY ELLEN RADOSEVICH FNP-C

MEDICARE: MARY ELLEN RADOSEVICH 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
1363L00000XNurse PractitionerAP3727AZ
2363LF0000XFamily Nurse PractitionerAP3727AZ

General Provider Information

NPI Number : 1245534726
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELLEN RADOSEVICH FNP-C
Provider Business Mailing Address
First Line : 4375 E IRMA LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4312
Country : US
Telephone Number : 480-890-5800
Fax Number :
Provider Business Practice Location Address
First Line : 4375 E IRMA LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4312
Country : US
Telephone Number : 480-890-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2010
Last Update Date : 03/16/2025

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