Healthcare Provider Details

I. General information

NPI: 1801119862
Provider Name (Legal Business Name): LUPITA FARMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 W CAROLINE ST
COOLIDGE AZ
85128-3535
US

IV. Provider business mailing address

544 W PIMA AVE
COOLIDGE AZ
85128-4206
US

V. Phone/Fax

Practice location:
  • Phone: 520-424-2100
  • Fax: 520-424-2110
Mailing address:
  • Phone: 520-705-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN036741
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: