Healthcare Provider Details

I. General information

NPI: 1285210708
Provider Name (Legal Business Name): AMELIA REAY CPP, LNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 S 51ST ST STE 100
PHOENIX AZ
85044-1789
US

IV. Provider business mailing address

11022 S 51ST ST STE 100
PHOENIX AZ
85044-1789
US

V. Phone/Fax

Practice location:
  • Phone: 480-912-1199
  • Fax:
Mailing address:
  • Phone: 480-912-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberWB4461
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number26355517
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberWB4460
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLNA1000031276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: