MEDICARE: RENAE SLOBODNY 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	363AM0700X	Medical Physician Assistant	6797	AZ

General Provider Information

NPI Number	:	1528586641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE SLOBODNY PA-C

Provider Business Mailing Address
First Line	:	4512 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3604
Country	:	US
Telephone Number	:	602-954-7546
Fax Number	:	602-952-2941

Provider Business Practice Location Address
First Line	:	4512 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3604
Country	:	US
Telephone Number	:	602-954-7546
Fax Number	:	602-952-2941

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

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	03/19/2019

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Directions to “ RENAE SLOBODNY PA-C” Practice Location

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