Healthcare Provider Details

I. General information

NPI: 1881860880
Provider Name (Legal Business Name): PERSONALLY DELIVERED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 E RAND PL
TUCSON AZ
85715-5833
US

IV. Provider business mailing address

9601 E RAND PL
TUCSON AZ
85715-5833
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-2347
  • Fax:
Mailing address:
  • Phone: 520-296-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberMP00527
License Number StateNV

VIII. Authorized Official

Name: LAURI PRIVETT
Title or Position: OWNER/MEMBER
Credential:
Phone: 520-296-2347