Facts
- Status
- A
- Credential
- rn
- Type
- Individual
- Enumeration date
- 2009-02-27
- Last updated
- 2009-04-30
Specialties
Licenses
- License PA
- rn274405l
Location
- Practice location
- HIGHWAY 98 AND NAVAJO ROUTE 16
- City
- TONALEA AZ
- Postal code
- 86044
- Phone
- 928-672-2983
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.