Basic Information
| Provider Information | |||||||||
| NPI: | 1033432620 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NODESTINE | ||||||||
| FirstName: | EUGENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4000 | ||||||||
| Address2: | HOPI HEALTH CARE CENTER | ||||||||
| City: | POLACCA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860424000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287376387 | ||||||||
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| Practice Location | |||||||||
| Address1: | HWY 264, MP 388 | ||||||||
| Address2: | HOPI HEALTH CARE CENTER | ||||||||
| City: | POLACCA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860424000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287376387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | CNA323705353 | AZ | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.