Healthcare Provider Details

I. General information

NPI: 1649954769
Provider Name (Legal Business Name): NIZHONI TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E CAMELBACK RD # 2046
PHOENIX AZ
85014-3687
US

IV. Provider business mailing address

PO BOX 4516
GALLUP NM
87305-4516
US

V. Phone/Fax

Practice location:
  • Phone: 623-224-3395
  • Fax:
Mailing address:
  • Phone: 623-224-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TANYA LIVINGSTON
Title or Position: MANAGING MEMBER
Credential:
Phone: 623-224-3395