Healthcare Provider Details

I. General information

NPI: 1235425554
Provider Name (Legal Business Name): KATHLEEN MARY ARVISO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF RTE N12 AND N7
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

PO BOX 649
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8468
  • Fax: 928-729-8530
Mailing address:
  • Phone: 928-729-8468
  • Fax: 928-729-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN144177
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: