Healthcare Provider Details

I. General information

NPI: 1114644432
Provider Name (Legal Business Name): CLAREL NEUVIEME
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE PORTAL
SIERRA VISTA AZ
85635-2967
US

IV. Provider business mailing address

414 AZURE CT
STOCKBRIDGE GA
30281-7005
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-1429
  • Fax:
Mailing address:
  • Phone: 404-482-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number282318
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: