MEDICARE: MS. DEBORAH ROSE DICICCO FNP

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	AP1474	AZ

General Provider Information

NPI Number	:	1770558272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH ROSE DICICCO FNP

Provider Business Mailing Address
First Line	:	34 W CAMBRIDGE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85003-1003
Country	:	US
Telephone Number	:	602-571-0040
Fax Number	:	602-745-7949

Provider Business Practice Location Address
First Line	:	3141 N 3RD AVE
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4351
Country	:	US
Telephone Number	:	602-745-7953
Fax Number	:	602-745-7949

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	07/08/2007

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