Basic Information
| Provider Information | |||||||||
| NPI: | 1437669504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BINGHAM | ||||||||
| FirstName: | CAROLINE | ||||||||
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| Credential: | AGPC-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12075 AZ STATE ROUTE 69 | ||||||||
| Address2: | |||||||||
| City: | DEWEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86327 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12075 AZ STATE ROUTE 69 | ||||||||
| Address2: | |||||||||
| City: | DEWEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287721673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2017 | ||||||||
| LastUpdateDate: | 10/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN210224 | TN | N | Nursing Service Providers | Registered Nurse | 363LG0600X | AP10622 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LP2300X | AP10622 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LA2200X | AP10622 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.