Healthcare Provider Details

I. General information

NPI: 1790034304
Provider Name (Legal Business Name): ANNE M. BRASHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 11TH ST
DOUGLAS AZ
85607-2738
US

IV. Provider business mailing address

1235 E 7TH ST
DOUGLAS AZ
85607-3008
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-2447
  • Fax:
Mailing address:
  • Phone: 520-364-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN032503
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: