MEDICARE: MS. BRENDA FAITH GEISLER 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	AP4525	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z170953	OTHER	AZ	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861736464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA FAITH GEISLER FNP-C

Provider Business Mailing Address
First Line	:	18404 N TATUM BLVD
Second Line	:	STE 101C
City	:	PHOENIX
State	:	AZ
Zip	:	85032-1511
Country	:	US
Telephone Number	:	602-485-7475
Fax Number	:

Provider Business Practice Location Address
First Line	:	6702 W BETHANY HOME RD STE 1314&15
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-4402
Country	:	US
Telephone Number	:	623-435-7000
Fax Number	:	623-435-3947

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

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	12/05/2019

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