Healthcare Provider Details

I. General information

NPI: 1336284942
Provider Name (Legal Business Name): NO ARIZ DERMATOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 S WILLARD ST
COTTONWOOD AZ
86326
US

IV. Provider business mailing address

1490 N TURQUOISE DR SAA
FLAGSTAFF AZ
86001
US

V. Phone/Fax

Practice location:
  • Phone: 928-639-9596
  • Fax: 928-639-0189
Mailing address:
  • Phone: 928-774-5074
  • Fax: 928-779-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. CYNTHIA ACKERMANN KNUTSON
Title or Position: CEO
Credential: MD
Phone: 928-774-5074