Provider Demographics
NPI:1811763915
Name:ROTELLA, ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROTELLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:ROTELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1338 W LOS LAGOS VIS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6643
Mailing Address - Country:US
Mailing Address - Phone:203-460-2747
Mailing Address - Fax:
Practice Address - Street 1:7575 E EARLL DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6998
Practice Address - Country:US
Practice Address - Phone:480-448-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3006862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry