MEDICARE: MRS. MARTHA FAY MONEYPENNY NP

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	363LG0600X	Gerontology Nurse Practitioner	RN065712	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639159106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA FAY MONEYPENNY NP

Provider Business Mailing Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	SUITE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	602-718-3050
Fax Number	:	602-943-4359

Provider Business Practice Location Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	SUITE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	602-718-3050
Fax Number	:	602-943-4359

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/24/2015

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