MEDICARE: SHELLY ROME N.P

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	163W00000X	Registered Nurse	RN061491	AZ
2	363LF0000X	Family Nurse Practitioner	AP0622	AZ

General Provider Information

NPI Number	:	1265869598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY ROME N.P

Provider Business Mailing Address
First Line	:	3514 N POWER RD
Second Line	:	SUITE 118
City	:	MESA
State	:	AZ
Zip	:	85215-2903
Country	:	US
Telephone Number	:	480-844-8346
Fax Number	:	480-844-3889

Provider Business Practice Location Address
First Line	:	3514 N POWER RD
Second Line	:	SUITE 118
City	:	MESA
State	:	AZ
Zip	:	85215-2903
Country	:	US
Telephone Number	:	480-844-8346
Fax Number	:	480-844-3889

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	03/16/2017

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Directions to “ SHELLY ROME N.P” Practice Location

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