Basic Information
| Provider Information | |||||||||
| NPI: | 1487755393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOURDAGE-ALLMAN | ||||||||
| FirstName: | TANA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4875 E BUFFALO GRASS CIR | ||||||||
| Address2: | |||||||||
| City: | RIMROCK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863356000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285672637 | ||||||||
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| Practice Location | |||||||||
| Address1: | NAVAHCS 550 NORTH HIGHWAY 89 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APO328 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.