Healthcare Provider Details

I. General information

NPI: 1548536063
Provider Name (Legal Business Name): CRYSTAL ANN LA TOUR R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 E. GINTER ROAD SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
TUCSON AZ
85706
US

IV. Provider business mailing address

2238 E. GINTER ROAD SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
TUCSON AZ
85706
US

V. Phone/Fax

Practice location:
  • Phone: 520-545-4800
  • Fax:
Mailing address:
  • Phone: 520-545-2137
  • Fax: 520-545-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN164454
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: