Healthcare Provider Details

I. General information

NPI: 1538167291
Provider Name (Legal Business Name): NANCY M. ELDREDGE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

377 S MEYER AVE
TUCSON AZ
85701-2231
US

IV. Provider business mailing address

PO BOX 85684
TUCSON AZ
85754-5684
US

V. Phone/Fax

Practice location:
  • Phone: 502-622-4950
  • Fax: 520-622-1227
Mailing address:
  • Phone: 502-622-4950
  • Fax: 520-622-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1684
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: