MEDICARE: LAURA ELIZABETH CHICCARELLO FNP-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	363L00000X	Nurse Practitioner	291427	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	:	1710754718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELIZABETH CHICCARELLO FNP-C

Provider Business Mailing Address
First Line	:	261 N ROOSEVELT AVE
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2617
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:	888-316-1686

Provider Business Practice Location Address
First Line	:	5102 W OLIVE AVE STE 101
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-4201
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:	888-316-1686

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

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	01/28/2026

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