Healthcare Provider Details

I. General information

NPI: 1851562680
Provider Name (Legal Business Name): ELIZABETH L VATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E OAK ST
HUACHUCA CITY AZ
85616-8188
US

IV. Provider business mailing address

501 E OAK ST
HUACHUCA CITY AZ
85616-8188
US

V. Phone/Fax

Practice location:
  • Phone: 520-220-6714
  • Fax:
Mailing address:
  • Phone: 520-220-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN109688
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: