Healthcare Provider Details

I. General information

NPI: 1942808431
Provider Name (Legal Business Name): VERA ADELL DUJMIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N WILMOT RD STE B
TUCSON AZ
85711-1712
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-290-1100
  • Fax: 520-290-8997
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-818-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number246226
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: