MEDICARE: HEALTHFUL HEALTHCARE PLLC

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
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1811603202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHFUL HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	14961 W BELL RD STE 100
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3203
Country	:	US
Telephone Number	:	623-606-5524
Fax Number	:

Provider Business Practice Location Address
First Line	:	14961 W BELL RD STE 100
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3203
Country	:	US
Telephone Number	:	623-439-5176
Fax Number	:	855-583-1420

Authorized Official
Title or Position	:	OWNER/ NURSE PRACTITIONER
Name	:	STEPHANIE BLACKMORE
Credential	:	APRN
Telephone Number	:	623-439-5176

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	10/10/2023

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