Healthcare Provider Details

I. General information

NPI: 1659894541
Provider Name (Legal Business Name): DESPINA CIOCANEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 S MALPAIS LN STE 108
FLAGSTAFF AZ
86001-6299
US

IV. Provider business mailing address

4550 E BELL RD STE 170
PHOENIX AZ
85032-9385
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10193
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: