Healthcare Provider Details

I. General information

NPI: 1871104950
Provider Name (Legal Business Name): NANCY RAE KLUG RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N FERGUSON AVE.
TUCSON AZ
85712
US

IV. Provider business mailing address

5301 E GRANT RD
TUCSON AZ
85712-2874
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-1010
  • Fax: 520-324-0029
Mailing address:
  • Phone: 520-270-8219
  • Fax: 520-324-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number09213256
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: