Healthcare Provider Details

I. General information

NPI: 1013415843
Provider Name (Legal Business Name): CAROLYNE ADERO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 S AVENUE A STE A
YUMA AZ
85364-8308
US

IV. Provider business mailing address

PO BOX 5510
YUMA AZ
85366-2475
US

V. Phone/Fax

Practice location:
  • Phone: 928-276-4381
  • Fax: 928-276-4381
Mailing address:
  • Phone: 928-276-4381
  • Fax: 928-276-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10716
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: