MEDICARE: NICOLE LYNN FERSCHKE PA

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	363A00000X	Physician Assistant	3684	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447448097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LYNN FERSCHKE PA

Provider Business Mailing Address
First Line	:	1138 N ALMA SCHOOL RD STE 120
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3003
Country	:	US
Telephone Number	:	888-306-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1138 N ALMA SCHOOL RD
Second Line	:	STE 120
City	:	MESA
State	:	AZ
Zip	:	85201-3002
Country	:	US
Telephone Number	:	623-293-0343
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	01/17/2019

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