MEDICARE: MRS. MARY J BOOTZ 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	AP8986	AZ

General Provider Information

NPI Number	:	1851842447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY J BOOTZ FNP

Provider Business Mailing Address
First Line	:	840 E MCKELLIPS RD STE 105
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-9654
Country	:	US
Telephone Number	:	602-491-0701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 E PECOS RD STE 215
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-3202
Country	:	US
Telephone Number	:	480-448-2411
Fax Number	:

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

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	06/11/2024

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