Basic Information
| Provider Information | |||||||||
| NPI: | 1457794414 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHERN ARIZONA HEALTHCARE SOLUTIONS P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1778 N HWY 89 | ||||||||
| Address2: | |||||||||
| City: | CHINO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863235695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284041488 | ||||||||
| FaxNumber: | 6022184443 | ||||||||
| Practice Location | |||||||||
| Address1: | 1778 N HWY 89 | ||||||||
| Address2: | |||||||||
| City: | CHINO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863235695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284041488 | ||||||||
| FaxNumber: | 6022184443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY/TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 9287721673 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F1108184 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP4015 | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | Z91357 | 01 | AZ | PTAN | OTHER | Z128381 | 01 | PTAN | OTHER |