Healthcare Provider Details

I. General information

NPI: 1831220854
Provider Name (Legal Business Name): PARKER INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY RD
PARKER AZ
85344-7718
US

IV. Provider business mailing address

801 W 11TH ST
PARKER AZ
85344-5815
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-3296
  • Fax:
Mailing address:
  • Phone: 928-669-3296
  • Fax: 928-669-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberRN029540
License Number StateAZ

VIII. Authorized Official

Name: ROBERTA CHRISTINE WAGNER
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 928-669-3296