Healthcare Provider Details

I. General information

NPI: 1962558569
Provider Name (Legal Business Name): NORTHERN ARIZONA DERMATOLOGY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 N TURQUOISE DR
FLAGSTAFF AZ
86001
US

IV. Provider business mailing address

1490 N TURQUOISE DR
FLAGSTAFF AZ
86001
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

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