MEDICARE: VICKIE CLOUS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP2228	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588681324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE CLOUS FNP

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:	520-818-3630

Provider Business Practice Location Address
First Line	:	287 E HUNT HWY STE 105
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-5096
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:	480-535-0962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/23/2019

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Directions to “ VICKIE CLOUS FNP” Practice Location

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