MEDICARE: MS. MARIA LOURDES GALVAN RN, CDE

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	163WD0400X	Diabetes Educator Registered Nurse	RN146982	AZ

General Provider Information

NPI Number	:	1487057436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA LOURDES GALVAN RN, CDE

Provider Business Mailing Address
First Line	:	PO BOX 548
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634-0548
Country	:	US
Telephone Number	:	520-383-7332
Fax Number	:	520-383-7343

Provider Business Practice Location Address
First Line	:	HWY 86 & TOPAWA RD.
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634-0548
Country	:	US
Telephone Number	:	520-383-7332
Fax Number	:	520-383-7343

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

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	10/06/2014

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