Provider Demographics
NPI:1689075293
Name:FATTORI, MARISOL (LPN)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:FATTORI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-2218
Mailing Address - Country:US
Mailing Address - Phone:623-876-7304
Mailing Address - Fax:
Practice Address - Street 1:7300 N DYSART RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-2218
Practice Address - Country:US
Practice Address - Phone:623-876-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTLP050399390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program