Healthcare Provider Details

I. General information

NPI: 1801040548
Provider Name (Legal Business Name): BUSANDA LEE FROST ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 04/11/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHIIH'TOH BLVD INDUSTRIAL BLDG
SANDERS AZ
86512-0125
US

IV. Provider business mailing address

PO BOX 649
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 928-688-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2248032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: