Healthcare Provider Details

I. General information

NPI: 1306866892
Provider Name (Legal Business Name): ROSALYN HARRIETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MAIN ST.
DUNCAN AZ
85534
US

IV. Provider business mailing address

PO BOX 1625
PAGE AZ
86040-1625
US

V. Phone/Fax

Practice location:
  • Phone: 928-359-1380
  • Fax: 928-359-1381
Mailing address:
  • Phone: 928-645-9675
  • Fax: 928-645-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2817
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: