Healthcare Provider Details

I. General information

NPI: 1205264041
Provider Name (Legal Business Name): VALLEY VIEW PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 HIGHWAY 95
BULLHEAD CITY AZ
86442-8151
US

IV. Provider business mailing address

3641 HIGHWAY 95
BULLHEAD CITY AZ
86442-8151
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-4337
  • Fax: 928-788-4332
Mailing address:
  • Phone: 928-788-4337
  • Fax: 928-788-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4484
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHARLOTTE E LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000