Individual
ADDIE RODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
105 S DELAWARE DR STE 2, APACHE JUNCTION, AZ 85120-6512
(480) 646-1001
(480) 646-1002
Mailing address
105 S DELAWARE DR STE 1, APACHE JUNCTION, AZ 85120-6512
(480) 646-1001
(480) 646-1002
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APN6179
TN
363LF0000X
Family Nurse Practitioner
Primary
AP3930
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4087938
BLUECROSS
TN
05
—
653785
—
AZ
05
—
78013760
—
KY
01
—
AP3930
LICENSE
AZ
Enumeration date
05/26/2006
Last updated
07/21/2022
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