MEDICARE: MRS. DAE LORETO FERNANDEZ

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	163WN0800X	Neuroscience Registered Nurse	RN129134	AZ

General Provider Information

NPI Number	:	1417259086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAE LORETO FERNANDEZ

Provider Business Mailing Address
First Line	:	5277 E JASMINE VISTA CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-8684
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5277 E JASMINE VISTA CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-8684
Country	:	US
Telephone Number	:	520-514-9495
Fax Number	:

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

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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