Healthcare Provider Details

I. General information

NPI: 1508831025
Provider Name (Legal Business Name): PAULA ANN CRINKLAW FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 W FRONTIER ST
APACHE JUNCTION AZ
85220
US

IV. Provider business mailing address

1485 W FRONTIER ST
APACHE JUNCTION AZ
85220-9134
US

V. Phone/Fax

Practice location:
  • Phone: 602-228-2254
  • Fax:
Mailing address:
  • Phone: 602-228-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1725
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: