MEDICARE: ANNIE MARIE RODMAN MSN/FNP

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	RN094835 AP1618	AZ

General Provider Information

NPI Number	:	1275837932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE MARIE RODMAN MSN/FNP

Provider Business Mailing Address
First Line	:	1510 E WAGON WHEEL LN
Second Line	:	SUITE 106
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6697
Country	:	US
Telephone Number	:	928-788-9378
Fax Number	:	928-788-9381

Provider Business Practice Location Address
First Line	:	1510 E WAGON WHEEL LN
Second Line	:	SUITE 106
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6697
Country	:	US
Telephone Number	:	928-788-9378
Fax Number	:	928-788-9381

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	01/10/2011

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