Healthcare Provider Details

I. General information

NPI: 1548787294
Provider Name (Legal Business Name): GREEN VALLEY FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W DUVAL MINE RD STE 106
GREEN VALLEY AZ
85614-5000
US

IV. Provider business mailing address

140 W DUVAL MINE RD STE 106
GREEN VALLEY AZ
85614-5000
US

V. Phone/Fax

Practice location:
  • Phone: 520-818-8477
  • Fax:
Mailing address:
  • Phone: 520-818-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDA ANN WELLS
Title or Position: OWNER
Credential: MD
Phone: 520-818-8477