Healthcare Provider Details

I. General information

NPI: 1215682984
Provider Name (Legal Business Name): GRACE AKECH OPIYO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 W EL CAMINO DEL CERRO
TUCSON AZ
85745-9252
US

IV. Provider business mailing address

4163 W EL CAMINO DEL CERRO
TUCSON AZ
85745-9252
US

V. Phone/Fax

Practice location:
  • Phone: 520-730-8364
  • Fax:
Mailing address:
  • Phone: 520-730-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number271086
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: