Healthcare Provider Details

I. General information

NPI: 1265114037
Provider Name (Legal Business Name): PATRICK DONALD THURBER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE PORTAL STE C240
SIERRA VISTA AZ
85635-2986
US

IV. Provider business mailing address

1100 N F AVE
DOUGLAS AZ
85607-1919
US

V. Phone/Fax

Practice location:
  • Phone: 520-354-1429
  • Fax:
Mailing address:
  • Phone: 520-364-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022139997
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: