Healthcare Provider Details

I. General information

NPI: 1700109295
Provider Name (Legal Business Name): KAY LYNN HONANIE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 264, MP 388 HOPI HEALTH CARE CENTER
POLACCA AZ
86042-4000
US

IV. Provider business mailing address

PO BOX 521
KYKOTSMOVI AZ
86039
US

V. Phone/Fax

Practice location:
  • Phone: 928-737-6003
  • Fax:
Mailing address:
  • Phone: 928-737-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN158416
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: