Healthcare Provider Details

I. General information

NPI: 1750652459
Provider Name (Legal Business Name): VICKI J FRENCH LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 F AVE
DOUGLAS AZ
85607-1919
US

IV. Provider business mailing address

1205 F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-3285
  • Fax: 520-364-4261
Mailing address:
  • Phone: 520-364-1429
  • Fax: 520-364-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLISAC-10182
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: