MEDICARE: MS. KARELLE I LABRADOR NP

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	270579	AZ

General Provider Information

NPI Number	:	1770469173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARELLE I LABRADOR NP

Provider Business Mailing Address
First Line	:	222 E JEFFERSON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-0400
Country	:	US
Telephone Number	:	630-398-1662
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 E JEFFERSON ST # 69
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-0400
Country	:	US
Telephone Number	:	630-398-1662
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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