Individual
MISS KELLY ANNE MAURER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2632 N 20TH ST, PHOENIX, AZ 85006-1339
(602) 266-2200
(602) 240-6177
Mailing address
PO BOX 61773, PHOENIX, AZ 85082-1773
(602) 266-2200
(602) 240-6177
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN064636
AZ
363LF0000X
Family Nurse Practitioner
Primary
2433
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173959
—
AZ
01
—
2433
AZ NP LICENSE
AZ
01
—
P00344216
RAILROAD MEDICARE
AZ
01
—
RN064636
RN LICENSE NUMBER
AZ
01
—
WCSKQ
SUN HEALTH GROUP #
AZ
Enumeration date
07/17/2006
Last updated
11/01/2007
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