Healthcare Provider Details

I. General information

NPI: 1841318094
Provider Name (Legal Business Name): ALICE MARY D'MOWSKI RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE SOUTHERN AZ VA HEALTH CARE SYSTEM
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

512 S 3RD AVE #1
TUCSON AZ
85701-2400
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 520-791-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number5124
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: