Healthcare Provider Details

I. General information

NPI: 1881847390
Provider Name (Legal Business Name): WOMEN FIRST GYN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5658 HIGHWAY 260 SUITE 19
LAKESIDE AZ
85929-5189
US

IV. Provider business mailing address

PO BOX 10
OVERGAARD AZ
85933-0010
US

V. Phone/Fax

Practice location:
  • Phone: 928-535-6667
  • Fax: 928-535-5561
Mailing address:
  • Phone: 928-535-6667
  • Fax: 928-535-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberAZ124895
License Number StateAZ

VIII. Authorized Official

Name: LORI S DRIGGS
Title or Position: PRESIDENT
Credential: NP
Phone: 480-239-8624