MEDICARE: BEATRIZ MILENA D MCCONNELL

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	286345	AZ

General Provider Information

NPI Number	:	1457134637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRIZ MILENA D MCCONNELL

Provider Business Mailing Address
First Line	:	13621 W GLENDALE AVE APT 1117
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85307-2038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13621 W GLENDALE AVE APT 1117
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85307-2038
Country	:	US
Telephone Number	:	206-581-5997
Fax Number	:

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/22/2023

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Directions to “ BEATRIZ MILENA D MCCONNELL ” Practice Location

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