Healthcare Provider Details

I. General information

NPI: 1801158936
Provider Name (Legal Business Name): SHEILA LYNELLE URIDIL APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13175 EAST HIGHWAY 169
DEWEY AZ
86027
US

IV. Provider business mailing address

PO BOX 47729
PHOENIX AZ
85068-7729
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-1155
  • Fax: 928-632-8295
Mailing address:
  • Phone: 623-934-5600
  • Fax: 632-934-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number111349
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP4742
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: