Basic Information
| Provider Information | |||||||||
| NPI: | 1821244351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4002 N GRANITE REEF RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852514921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026975111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HIGHWAY 89 NORTH | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 08/15/2008 | ||||||||
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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 | 164W00000X | PN-111351 | OH | N | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | LP038334 | AZ | Y | Nursing Service Providers | Licensed Practical Nurse | 164X00000X | VN203660 | CA | N | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.