Healthcare Provider Details

I. General information

NPI: 1285635037
Provider Name (Legal Business Name): NANCY LYNNE NAMKA ED. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LYNNE NAMKA ED. D.

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7493 N ORACLE RD SUITE 123
TUCSON AZ
85704-6343
US

IV. Provider business mailing address

5398 E GOLDER RANCH DR
TUCSON AZ
85739-4270
US

V. Phone/Fax

Practice location:
  • Phone: 520-825-4766
  • Fax: 520-825-0556
Mailing address:
  • Phone: 520-825-4766
  • Fax: 520-825-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1236
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: