MEDICARE: MS. DEBRA GAIL MAMMEN 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	363LF0000X	Family Nurse Practitioner	AZ2171	AZ

General Provider Information

NPI Number	:	1831170711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA GAIL MAMMEN FNP-C

Provider Business Mailing Address
First Line	:	931 W SHERRI DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-7935
Country	:	US
Telephone Number	:	480-518-1488
Fax Number	:	480-777-2331

Provider Business Practice Location Address
First Line	:	3200 N DOBSON RD
Second Line	:	SUITE F3
City	:	CHANDLER
State	:	AZ
Zip	:	85224-9601
Country	:	US
Telephone Number	:	480-838-4277
Fax Number	:	480-777-2331

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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