Basic Information
| Provider Information | |||||||||
| NPI: | 1295453165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | CHINE | ||||||||
| MiddleName: | QUETZALCOATL TAN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10659 E ROSE HILL ST | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857475961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202470451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 335 S OCOTILLO AVE | ||||||||
| Address2: | |||||||||
| City: | BENSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856026406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205864040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F06221757 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 218258 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.