| NPI | 1477858801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH ANN NICHOLS Principal Officer 928-595-1176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: AZ AP1489) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: AZ AP1489) |
| 310400000X Assisted Living Facility (Licence: AZ AP1489) | |
| 314000000X Skilled Nursing Facility (Licence: AZ AP1489) | |
| Enumeration Date | 2011-01-15 |
| Last Update Date | 2014-02-04 |