MEDICARE: MARY PAT NESBIT PA

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	363A00000X	Physician Assistant	59918	CA
2	207P00000X	Emergency Medicine Physician	2601	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CO301824	OTHER	AZ	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3981220	OTHER		EVERCARE GROUP #
3	A1U1436	OTHER	AZ	HEALTHNET GROUP #
4	453051001	OTHER		GROUP HEALTH GRP #
6	860373636	OTHER	AZ	HUMANA GROUP #

General Provider Information

NPI Number	:	1982695615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY PAT NESBIT PA

Provider Business Mailing Address
First Line	:	14780 W MOUNTAIN VIEW BLVD
Second Line	:	STE 110
City	:	SURPRISE
State	:	AZ
Zip	:	85374-7280
Country	:	US
Telephone Number	:	623-374-7774
Fax Number	:	855-420-6361

Provider Business Practice Location Address
First Line	:	1201 S 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007
Country	:	US
Telephone Number	:	602-258-5111
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	11/09/2022

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Directions to “ MARY PAT NESBIT PA” Practice Location

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