Healthcare Provider Details

I. General information

NPI: 1760297857
Provider Name (Legal Business Name): HILARY S DEEREN OKELLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E BROADWAY AVE
APACHE JUNCTION AZ
85119-9301
US

IV. Provider business mailing address

3701 E BROADWAY AVE
APACHE JUNCTION AZ
85119-9301
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-7510
  • Fax:
Mailing address:
  • Phone: 480-677-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN081688
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: