Healthcare Provider Details

I. General information

NPI: 1194909499
Provider Name (Legal Business Name): EVELYN TODACHEENE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JCT. US HWY 160 & NAVAJO ROUTE 35 RED MESA
TEECNOSPOS AZ
86514
US

IV. Provider business mailing address

BOX 30 HCR 6100
TEECNOSPOS AZ
86514
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5165
  • Fax: 928-656-5164
Mailing address:
  • Phone: 928-656-5165
  • Fax: 928-656-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR25071
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: