Basic Information
| Provider Information | |||||||||
| NPI: | 1689824476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAY | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | HC 61 BOX 30 | ||||||||
| Address2: | FOUR CORNERS REGIONAL HEALTH CENTER | ||||||||
| City: | TEEC NOS POS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865149600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | 9286565164 | ||||||||
| Practice Location | |||||||||
| Address1: | HC 61 BOX 30 | ||||||||
| Address2: | JCT. U.S. HWY 160 & NAVAJO ROUTE 35-RED MESA | ||||||||
| City: | TEEC NOS POS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865149600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | 9286565164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN134856 | AZ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.