MEDICARE: MARIA IZDEBSKI

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	363LF0000X	Family Nurse Practitioner	RN103493	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	:	1700196250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA IZDEBSKI

Provider Business Mailing Address
First Line	:	9815 E CINNABAR AVE
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4737
Country	:	US
Telephone Number	:	480-455-3000
Fax Number	:	866-819-6115

Provider Business Practice Location Address
First Line	:	20823 N CAVE CREEK RD
Second Line	:	STE 103
City	:	PHOENIX
State	:	AZ
Zip	:	85024-4469
Country	:	US
Telephone Number	:	623-399-8606
Fax Number	:	623-399-8606

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

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	04/05/2017

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