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General NPI Number Information
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NPI Number | 1205909041
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Entity Type | Individual
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Provider Name | AMY CARLEEN NEGOVAN CPNP
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 1003 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1641
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Country | US
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Telephone | 928-771-5662
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Fax | 928-771-5249
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Provider Business Mailing Address
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Address Line | 13421 JEFFERSON AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-6019
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Country | US
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Telephone | 310-978-1467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 164403
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License Number State | AZ
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