Healthcare Provider Details

I. General information

NPI: 1629306436
Provider Name (Legal Business Name): BEVERLY O'BRALLAGHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY ROAD PARKER INDIAN HEALTHCARE CENTER
PARKER AZ
85344
US

IV. Provider business mailing address

12033 AGENCY RD. PARKER INDIAN HEALTHCARE CENTER
PARKER AZ
85344
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-3130
  • Fax: 928-669-3131
Mailing address:
  • Phone: 928-669-3130
  • Fax: 928-669-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number081065
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: