Provider Demographics
NPI:1700583341
Name:RADZYKEWYCZ, RICHELLE ANN TUAZON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RICHELLE ANN
Middle Name:TUAZON
Last Name:RADZYKEWYCZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:RICHELLE ANN
Other - Middle Name:MENDOZA
Other - Last Name:TUAZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:3090 N LITCHFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9214
Practice Address - Country:US
Practice Address - Phone:623-536-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP283547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily