MEDICARE: MRS. ROSEFEL BIGLETE ANDAYA

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	TRN201660	AZ
2	163W00000X	Registered Nurse	041327998	IL

General Provider Information

NPI Number	:	1740722164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSEFEL BIGLETE ANDAYA

Provider Business Mailing Address
First Line	:	1250 W GROVE PKWY APT 1053
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-4440
Country	:	US
Telephone Number	:	773-391-2645
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 W GROVE PKWY APT 1053
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-4440
Country	:	US
Telephone Number	:	773-391-2645
Fax Number	:

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

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	11/16/2016

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