Healthcare Provider Details

I. General information

NPI: 1386047850
Provider Name (Legal Business Name): EMILY E VONA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 ACOMA BLVD N STE 104
LAKE HAVASU CITY AZ
86403
US

IV. Provider business mailing address

84 ACOMA BLVD N STE 104
LAKE HAVASU CITY AZ
86403-6096
US

V. Phone/Fax

Practice location:
  • Phone: 928-733-5101
  • Fax:
Mailing address:
  • Phone: 330-354-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223620
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number223620
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: