Healthcare Provider Details

I. General information

NPI: 1225245103
Provider Name (Legal Business Name): CLAUDIA JEAN VERVILLE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S STANFIELD RD
STANFIELD AZ
85272-9687
US

IV. Provider business mailing address

515 S STANFIELD RD
STANFIELD AZ
85272-9687
US

V. Phone/Fax

Practice location:
  • Phone: 520-424-3353
  • Fax: 520-424-3798
Mailing address:
  • Phone: 520-424-3353
  • Fax: 520-424-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number729874
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: