Healthcare Provider Details

I. General information

NPI: 1548949449
Provider Name (Legal Business Name): ANNE R KUZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 N MAIN ST
COTTONWOOD AZ
86326-3502
US

IV. Provider business mailing address

PO BOX 323
COTTONWOOD AZ
86326-0323
US

V. Phone/Fax

Practice location:
  • Phone: 406-260-8423
  • Fax:
Mailing address:
  • Phone: 406-260-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-012165
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: