Healthcare Provider Details

I. General information

NPI: 1679596092
Provider Name (Legal Business Name): AVONDALE ELEMENTARY SCHOOL DISTRICT #44
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W WESTERN AVE
AVONDALE AZ
85323-1848
US

IV. Provider business mailing address

235 W WESTERN AVE
AVONDALE AZ
85323-1848
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-5091
  • Fax: 623-772-5090
Mailing address:
  • Phone: 623-772-5091
  • Fax: 623-772-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN043598
License Number StateAZ

VIII. Authorized Official

Name: MRS. PAT PERRYMAN
Title or Position: PSYCHOLOGIST
Credential: DIRECTOR
Phone: 623-772-5091