Healthcare Provider Details

I. General information

NPI: 1689701682
Provider Name (Legal Business Name): LORETTA JO NEVAREZ-KELLS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19646 N 27TH AVE STE. # 403
PHOENIX AZ
85027-4017
US

IV. Provider business mailing address

1760 E RIVER RD SUITE # 350
TUCSON AZ
85718-5877
US

V. Phone/Fax

Practice location:
  • Phone: 623-587-4868
  • Fax: 623-582-5300
Mailing address:
  • Phone: 520-519-7775
  • Fax: 520-519-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP6844
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN047854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: