| NPI | 1659553139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN L COLVIN Owner 928-634-7470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ DO2771) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP0586) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ FNP361) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2008-02-27 |