MEDICARE: PAM STANDERFER

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	163W00000X	Registered Nurse	RN052009	AZ

General Provider Information

NPI Number	:	1659768760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAM STANDERFER

Provider Business Mailing Address
First Line	:	6020 N 2ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1211
Country	:	US
Telephone Number	:	602-347-4871
Fax Number	:	602-347-4821

Provider Business Practice Location Address
First Line	:	6020 N 2ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1211
Country	:	US
Telephone Number	:	602-347-4871
Fax Number	:	602-347-4821

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	04/16/2015

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Directions to “ PAM STANDERFER ” Practice Location

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