Healthcare Provider Details

I. General information

NPI: 1174698559
Provider Name (Legal Business Name): VALERIE MATTHEWS CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11219 E SHADY LN
TUCSON AZ
85749-9776
US

IV. Provider business mailing address

11219 E SHADY LN
TUCSON AZ
85749-9776
US

V. Phone/Fax

Practice location:
  • Phone: 520-731-1083
  • Fax: 520-207-2244
Mailing address:
  • Phone: 520-731-1083
  • Fax: 520-207-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 076668
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: