Healthcare Provider Details

I. General information

NPI: 1538023635
Provider Name (Legal Business Name): MARIA GUADALUPE UDAVE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N WILLARD ST
COTTONWOOD AZ
86326-3651
US

IV. Provider business mailing address

4835 E BEAVER CREEK RD
RIMROCK AZ
86335-6224
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-2288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number332292
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: