Mary Lou Aleck, PNP – Pediatric Nurse Practitioner

Key facts

NPI: 1992896534
Entity type: Individual (NPI type 1)
Primary specialty: Pediatric Nurse Practitioner 363LP0200X
License: 039615 (AZ)
Practice address: 2601 E Roosevelt St
Department of Pediatrics
Phoenix, AZ 85008-4973
Phone: (602) 344-5418
Fax: (602) 344-5859
NPI assigned: Sep 27, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

District Medical Group, Inc Internal Medicine Physician · Phoenix, AZ · NPI 1295968162

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
039615	AZ	MD	Pediatric Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
District Medical Group, Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Nurse Practitioner	363LP0200X	039615	AZ	Yes

Addresses

Primary practice location

2601 E Roosevelt St
Department of Pediatrics
Phoenix, AZ 85008-4973

Mailing address

2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000

Other identifiers

Identifier	Type	State	Issuer
445868	Medicaid	AZ

Other providers in Phoenix, AZ

All providers in Phoenix, AZ · Pediatric Nurse Practitioner in Arizona

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.