Provider Demographics
NPI:1205946175
Name:RZEWNICKI, DOROTHY J (PNP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:J
Last Name:RZEWNICKI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:J
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:602-933-1820
Practice Address - Street 1:205 S DOBSON RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6183
Practice Address - Country:US
Practice Address - Phone:480-963-6668
Practice Address - Fax:480-963-6669
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1116363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ824103Medicaid
AZ824103Medicaid
AZ109295Medicare ID - Type UnspecifiedMEDICARE #