Healthcare Provider Details

I. General information

NPI: 1972769388
Provider Name (Legal Business Name): LARAYNE ANNETTE NESS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WILLOW CREEK RD SUITE G
PRESCOTT AZ
86301-1645
US

IV. Provider business mailing address

511 HALE ST
EATON RAPIDS MI
48827-1829
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-7343
  • Fax: 928-257-4422
Mailing address:
  • Phone: 586-531-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60143760
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3075
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: