=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245845692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMON NAVA JR. FNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2020
-----------------------------------------------------
Last Update Date | 11/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 162 W EVERGREEN PEAR AVE
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85140-7911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-543-0601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 162 W EVERGREEN PEAR AVE
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85140-7911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-543-0601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2020066397
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------