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General NPI Number Information
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NPI Number | 1093908527
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Entity Type | Organization
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Legal Business Name | CAMP VERDE FAMILY HEALTH LLC
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 460 W FINNIE FLATS RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-7266
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Country | US
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Telephone | 928-639-5555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3340
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City | CAMP VERDE
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State | AZ
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Zip | 86322-3340
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Country | US
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Telephone | 928-639-5555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DELYTE NASCH
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Credential | FNP-C
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Telephone | 928-639-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP2777
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License Number State | AZ
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