MEDICARE: RACHEL MARIE NORDMEIER PA-C

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	4693	AZ

General Provider Information

NPI Number	:	1457661241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE NORDMEIER PA-C

Provider Business Mailing Address
First Line	:	41810 N VENTURE DR
Second Line	:	E-160
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3169
Country	:	US
Telephone Number	:	623-465-4627
Fax Number	:	623-594-8919

Provider Business Practice Location Address
First Line	:	41810 N VENTURE DR
Second Line	:	E-160
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3169
Country	:	US
Telephone Number	:	623-465-4627
Fax Number	:	623-594-8919

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

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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