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NPI Code Detail

MEDICARE: CHARLOTTE ANNE THRALL FNP-C

MEDICARE: CHARLOTTE ANNE THRALL 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
1363LF0000XFamily Nurse PractitionerAP3946AZ

General Provider Information

NPI Number : 1891076436
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOTTE ANNE THRALL FNP-C
Provider Business Mailing Address
First Line : 3400 E. MCDOWELL STREET
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-7899
Country : US
Telephone Number : 602-225-0595
Fax Number :
Provider Business Practice Location Address
First Line : 3400 E MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-3884
Country : US
Telephone Number : 602-225-0595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2011
Last Update Date : 09/08/2011

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