Basic Information
Provider Information
NPI: 1023205424
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOLLE
FirstName: ANNETTE
MiddleName: S.
NamePrefix: MS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5055 E BROADWAY BLVD
Address2: A-100
City: TUCSON
State: AZ
PostalCode: 857113640
CountryCode: US
TelephoneNumber: 5205474906
FaxNumber: 5207950225
Practice Location
Address1: 6236 E PIMA ST
Address2:  
City: TUCSON
State: AZ
PostalCode: 857123154
CountryCode: US
TelephoneNumber: 5203276874
FaxNumber: 5203270028
Other Information
ProviderEnumerationDate: 09/28/2007
LastUpdateDate: 09/28/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN132154AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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