MEDICARE: ASHLEY GONZALEZ MEDRANO

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	363L00000X	Nurse Practitioner	224697	AZ

General Provider Information

NPI Number	:	1497309330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GONZALEZ MEDRANO

Provider Business Mailing Address
First Line	:	23055 E CALLE DE FLORES
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1259
Country	:	US
Telephone Number	:	602-793-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 N SAN FRANCISCO ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3294
Country	:	US
Telephone Number	:	520-244-0089
Fax Number	:

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

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/30/2025

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