Provider Demographics
NPI:1295008191
Name:MAYTORENA, LOURDES ARACELI (RN)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:ARACELI
Last Name:MAYTORENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 E ROSE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1600
Mailing Address - Country:US
Mailing Address - Phone:602-664-7400
Mailing Address - Fax:602-664-7499
Practice Address - Street 1:1155 E ROSE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1600
Practice Address - Country:US
Practice Address - Phone:602-664-7400
Practice Address - Fax:602-664-7499
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN166841163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool