Basic Information
| Provider Information | |||||||||
| NPI: | 1710063490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARGILL | ||||||||
| FirstName: | JULIANA | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ANP GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1459 MARVIN GARDENS LN | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863015520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287768523 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 N HWY 89 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| 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 | 163W00000X | RN108844 | AZ | X | Nursing Service Providers | Registered Nurse | 363L00000X | AP1063 | AZ | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.