MEDICARE: REBECCA L RODGERS RNFA

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	364SP2800X	Perioperative Clinical Nurse Specialist	RN032360	AZ

General Provider Information

NPI Number	:	1710143599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L RODGERS RNFA

Provider Business Mailing Address
First Line	:	PO BOX 93656
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85070-3656
Country	:	US
Telephone Number	:	480-704-5080
Fax Number	:	480-706-5247

Provider Business Practice Location Address
First Line	:	500 N 56TH ST
Second Line	:	STE 5
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2506
Country	:	US
Telephone Number	:	480-704-5080
Fax Number	:	480-706-5247

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

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	07/31/2008

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