MEDICARE: MRS. HEATHER NOLL 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	AP5065	AZ

General Provider Information

NPI Number	:	1376982462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER NOLL FNP

Provider Business Mailing Address
First Line	:	2492-2930 E CAMELBACK RD
Second Line	:	STE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4412
Country	:	US
Telephone Number	:	480-263-0426
Fax Number	:	480-429-3467

Provider Business Practice Location Address
First Line	:	4600 E WASHINGTON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1903
Country	:	US
Telephone Number	:	888-371-5376
Fax Number	:	480-429-3467

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	12/18/2016

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