Provider Demographics
NPI:1538575253
Name:BUCCHIREDDIGARI, LOKESWARI
Entity type:Individual
Prefix:
First Name:LOKESWARI
Middle Name:
Last Name:BUCCHIREDDIGARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOKESWARI
Other - Middle Name:
Other - Last Name:NAGARAJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6401 E THOMAS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6078
Mailing Address - Country:US
Mailing Address - Phone:480-941-4400
Mailing Address - Fax:480-948-1100
Practice Address - Street 1:641 W WARNER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233
Practice Address - Country:US
Practice Address - Phone:480-722-9828
Practice Address - Fax:480-722-9831
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ977793Medicaid