Healthcare Provider Details

I. General information

NPI: 1780834622
Provider Name (Legal Business Name): MAXINE KLINGER HOWINGTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46999 N FIFTH ST
ASH FORK AZ
86320-0247
US

IV. Provider business mailing address

46999 NORTH FIFTH STREET
ASH FORK AZ
86320
US

V. Phone/Fax

Practice location:
  • Phone: 928-637-2561
  • Fax: 928-637-2623
Mailing address:
  • Phone: 928-637-2561
  • Fax: 928-637-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN046591
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: