Healthcare Provider Details

I. General information

NPI: 1841667334
Provider Name (Legal Business Name): ELLEN M HUFF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E DEUCE OF CLUBS
SHOW LOW AZ
85901-4808
US

IV. Provider business mailing address

PO BOX 2680
SHOW LOW AZ
85902-2680
US

V. Phone/Fax

Practice location:
  • Phone: 928-532-3926
  • Fax:
Mailing address:
  • Phone: 928-532-3926
  • Fax: 928-537-9634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8089
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: