Healthcare Provider Details

I. General information

NPI: 1043478431
Provider Name (Legal Business Name): PAUL ANTHONY CLAW FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL ANTHONY FNP

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 64
TSAILE AZ
86556
US

IV. Provider business mailing address

PO DRAWER PH - CCHCF
CHINLE AZ
86503
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-7166
  • Fax: 928-674-7705
Mailing address:
  • Phone: 928-674-7166
  • Fax: 928-674-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2963
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: