MEDICARE: ANNA VERHAGE AG-ACNP

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	363LA2100X	Acute Care Nurse Practitioner	AP7364	AZ

General Provider Information

NPI Number	:	1891189775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA VERHAGE AG-ACNP

Provider Business Mailing Address
First Line	:	7636 N DREAMY DRAW DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7636 N DREAMY DRAW DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4605
Country	:	US
Telephone Number	:	773-459-4917
Fax Number	:

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

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	03/27/2015

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